Antepartum
The laboratory blood tests of a client at 10 weeks' gestation reveal that she has anemia. The client refuses iron supplements. The nurse teaches her that the best source of iron is liver. What other foods does the nurse encourage the client to eat? Select all that apply. 1 Dark leafy green vegetables 2 Legumes 3 Dried fruits 4 Broiled halibut 5 Ground beef patty
Answer: 1, 2, 3, 5 Excellent food sources of iron include liver, meats, whole grain or enriched breads, dark green leafy vegetables, legumes, and dried fruits. Halibut is a good source of protein, not iron.
A 42-year-old client undergoes amniocentesis during the 16th week of gestation because of concern about Down syndrome. Which additional information about the fetus will examination of the amniotic fluid reveal at this time? 1 Lung maturity 2 Type 1 diabetes 3 Cardiac anomaly 4 Neural tube defec
Answer: 4 Alpha-fetoprotein in amniotic fluid is increased in the presence of a neural tube defect. Lung maturity cannot be determined until after 35 weeks' gestation. Neither diabetes nor cardiac disorders can be detected with the use of amniocentesis.
The nurse discusses the recommended weight gain during pregnancy with a newly pregnant client who is 5 ft 3 in (160 centimeters) tall and weighs 130 lb (57 kilograms). The nurse explains that with the recommended weight gain, at term the client should weigh how much? 1 155 lb (70 kg) 2 140 lb (63.5 kg) 3 135 lb (61 kg) 4 130 lb (57 kg)
Answer: 1 A weight of 155 lb (70 kg) would put the client within the recommended weight gain of at least 25 lb (11 kg) for a woman who was of average weight for her height before pregnancy. A weight of 140 lb (63.5 kg) is less than the recommended weight gain for a woman of average weight for height before pregnancy, as are 135 lb (61 kg) and 130 lb (57 kg). Recommendations are that women with a normal body mass index (BMI) should gain 25 to 35 lb (11.3 to 15.9 kg) during pregnancy.
A nurse is discussing diet with a pregnant client who is 5 feet 4 inches tall (163 cm) and whose pre-pregnancy weight was 120 lb (54 kg). What should the nurse include about the changes in calories and nutrients, compared with the pre-pregnancy diet, during the second trimester? 1 Decreasing daily fat consumption by 220 calories 2 Increasing total daily caloric intake by 340 calories 3 Increasing total daily caloric intake by 460 calories 4 Decreasing daily carbohydrate consumption by 130 calories
Answer: 2 A daily increase of 340 calories is recommended for adult women during the second trimester of pregnancy. Decreasing fat or carbohydrates in the diet will result in weight reduction, which is not recommended during pregnancy. A daily increase of 462 calories is recommended for adult women during the third trimester of pregnancy.
A client tells the nurse that the first day of her last menstrual period was July 22. What is the estimated date of birth (EDB)? 1 May 7 2 April 29 3 April 22 4 March 6
Answer: 2 Her EDB is April 29. The Nägele rule is an indirect, noninvasive method for estimating the date of birth: EDB = last menstrual period + 1 year - 3 months + 7 days. May 7 is beyond the expected date of birth. April 22 and March 6 are both before the EDB.
A nurse teaches a pregnant woman about the need to increase her intake of complete proteins. Which foods identified by the client indicate that the teaching is effective? Select all that apply. 1 Nuts 2 Milk 3 Eggs 4 Bread 5 Beans 6 Chees
Answer: 2,3, 6 Milk contains animal proteins, which are complete proteins that contain all of the essential amino acids. Eggs contain animal proteins, which are complete proteins that contain all the essential amino acids. Cheese contains milk, which is a complete protein that contains all of the essential amino acids. Nuts are incomplete proteins. Bread is not a complete protein. Beans are not complete proteins unless eaten in a specific combination with soy products.
At a routine monthly visit, while assessing a client who is in her 26th week of gestation, the nurse identifies the presence of striae gravidarum. The nurse describes this condition to the client as what? 1 Brownish blotches on the face 2 Purplish discoloration of the cervix 3 Reddish streaks on the abdomen and breasts 4 A black line running between the umbilicus and mons veneris
Answer: 3 Reddish streaks on the abdomen and breasts are striae gravidarum; they occur as a result of stretching of the breast and abdominal skin. These are known as "stretch marks." Chloasma refers to the condition where brownish blotches develop on the face. Purplish discoloration of the cervix is Chadwick sign. A black line running between the umbilicus and mons veneris is the linea nigra.
A client exhibits oligohydramnios at 36 weeks' gestation. What newborn complication should the nurse anticipate? 1 Spina bifida 2 Imperforate anus 3 Tracheoesophageal fistula 4 Intrauterine growth restriction (IUGR)
Answer: 4 Oligohydramnios is associated with IUGR; risk factors for IUGR include inadequate maternal nutrition and other high-risk conditions such as diabetes and preeclampsia. Spina bifida does not affect amniotic fluid volume; it is associated with an increased alpha-fetoprotein level. Imperforate anus does not affect amniotic fluid volume. Tracheoesophageal fistula is often associated with polyhydramnios, which is excessive amniotic fluid.
How does the nurse determine when true labor and not false labor is present? 1 Cervical dilation is evident. 2 Contractions stop when the client walks around. 3 The client's contractions progress only when she is in a side-lying position. 4 Contractions occur immediately after the membranes rupture.
Answer: 1 Progressive cervical dilation is the most accurate indication of true labor. With true labor, contractions will increase with activity. Contractions of true labor persist in any position. Contractions may not begin until 24 to 48 hours after the membranes rupture.
A primigravida in her seventh week of gestation asks the nurse when she can expect to feel her baby move. The nurse replies that quickening usually occurs in which week? 1 24th week 2 20th week 3 16th week 4 12th week
Answer: 2 Most primigravidas feel movement by the 20th week of gestation. The 24th week is very late for the pregnant woman to feel initial movement; lack of movement by the 24th week should be investigated. Multiparas may feel movement by the 16th week; however, most primigravidas feel movement between 18 and 20 weeks. Twelve weeks is too early for movement to be felt.
A nurse in the birthing unit is admitting a client whose membranes ruptured at home. How does the nurse know whether the client is in true labor? 1 Contractions occur every 10 minutes with no change in frequency over 2 hours, and the cervix is closed. 2 Contractions are not evident; the cervix is dilated 3 cm and 50% effaced, and there is no change after 4 hours of staying out of bed. 3 Contractions occur every 5 to 10 minutes, the cervix is dilated 2 cm and 75% effaced, and dilation has increased to 3 cm in 2 hours. 4 Contractions are irregular, occurring every 10 to 15 minutes, the cervix is dilated one fingertip and is 50% effaced, and there is no change with 4 hours of bed rest.
Answer: 3 Progressive cervical dilation and regular contractions that become progressively closer and increase in intensity are indications of true labor. The other options are not indications of true labor.
Laboratory studies reveal that a pregnant client's blood type is O, and she is Rh positive. The client asks whether her newborn will have a problem with blood incompatibility. Before responding, the nurse must remember that fetal problems may develop in what circumstance? 1 The fetus has type A or B blood. 2 The fetus is born preterm. 3 The fetus has type O, Rh positive blood. 4 The mother has diabetes.
Answer: 1 ABO incompatibility may develop even in a firstborn infant. The mother has antibodies against antigens of the A and B blood cells. These antibodies, which are transferred across the placenta, produce hemolysis of fetal red blood cells. If the fetus is type A, B, or AB, incompatibility may occur. Preterm birth will not produce an incompatibility; however, it may intensify problems if an incompatibility exists. If the baby has the same blood type and Rh factor as the mother, an incompatibility is unlikely. The infant of a diabetic mother will not develop an incompatibility; but, problems may be intensified if an incompatibility exists.
A nurse is assessing a client at 16 weeks' gestation. Where does the nurse expect the fundal height to be located? 1 Above the umbilicus 2 At the level of the umbilicus 3 Half the distance to the umbilicus 4 Slightly above the symphysis pubis
Answer: 3 Considering the growth of the fetus, this is the expected height of the fundus at 16 weeks' gestation. The height of the fundus in centimeters is approximately the same as the number of weeks of gestation if the woman's bladder is empty at the time of measurement. Above the umbilicus is where the fundus should be palpated from after 24 weeks' gestation until term. At the level of the umbilicus is where the fundus should be palpated at 22 to 24 weeks' gestation. Between 12 and 14 weeks' gestation, the uterus outgrows the pelvic cavity and can be palpated just above the symphysis pubis.
At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. Which intervention is important when the nurse discusses this finding with the client? 1 Asking her whether she has ever had German measles and when she had the disease 2 Arranging for her to receive the rubella booster vaccine after the birth 3 Planning for her to receive the rubella booster vaccine at her next visit 4 Informing her that the result was expected and that treatment will not be needed
Answer: 1 The positive result indicates that the client has had rubella or was vaccinated. The nurse should determine whether she has had the disease, because it is important to know whether it was before or after she became pregnant; if she had rubella at the start of her pregnancy, the fetus is at risk. A rubella booster, either at the next visit or after the birth, is not necessary because the client has active immunity. More information is needed before the client can be told that no treatment will be needed.
At a client's first prenatal visit, the nurse-midwife performs a pelvic examination. The nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. What does the nurse respond with about this expected finding? 1 "It helps confirm your pregnancy." 2 "It is not unusual, even in women who are not pregnant." 3 "It occurs because the blood is trapped by the pregnant uterus." 4 "It is caused by increased blood flow to the uterus during pregnancy."
Answer: 4 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.
A client who is visiting the prenatal clinic for the first time has a serology test for toxoplasmosis. What information about the client's activities in the history indicates to the nurse that there is a need for this test? 1 The client cares for a neighbor's cat 2 The client works as a dog trainer 3 The client uses chemical cleaners 4 The client consumes raw vegetables
Toxoplasmosis is caused by a protozoal parasite; cats acquire the organism by ingesting infected mice or birds, and the cysts are found in their feces. Caring for or working with cats, not dogs, poses a potential problem with toxoplasmosis. Chemical cleaners may be teratogenic, but they do not cause toxoplasmosis. Eating raw vegetables of any kind will not cause toxoplasmosis.
A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. What should the nurse include? Select all that apply. 1 Sleep needs increase 2 Urinary frequency 3 Body temperature decreases 4 Calcium requirements remain the same 5 The need for carbohydrates decreases
Answer: 1, 2, 4 Estrogen increases the secretion of corticosteroids, which decrease the basal metabolic rate, resulting in fatigue. Sodium is retained. Urinary frequency occurs. During the first trimester approximately 1000 mg of calcium is needed each day. There is no longer a recommendation for an increase in daily calcium intake during pregnancy and lactation. The daily recommended intake of 1000 mg for women older than 19 years and 1300 mg for women younger than 19 years is adequate for fetal bone and tooth development. Body temperature increases because of the increased metabolism related to the growth of the fetus. Carbohydrate needs increase because the secretion of insulin by the pancreas is increased; however, insulin is destroyed rapidly by the placenta. The stress of pregnancy may precipitate gestational diabetes.
A nurse caring for a pregnant client at 28 weeks' gestation and her partner suspects intimate partner violence. Which assessments support this suspicion? Select all that apply. 1 The woman has injuries to the breasts and abdomen. 2 The partner refuses to come into the examination room. 3 The partner answers questions that are asked of the woman. 4 The woman has visited the clinic several times in the last month. 5 The partner is excessively attentive while the health history is being taken.
Answer: 1, 3, 4 During pregnancy, batterers may concentrate their anger at the pregnancy itself and focus their assaults on the breasts, buttocks, and abdomen. It is 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. 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. Excessive attentiveness while the health history is being taken is not typical behavior of an abusive person.
A client in her tenth week of pregnancy exhibits presumptive signs of pregnancy. Which clinical findings may the nurse determine upon assessment? Select all that apply. 1 Amenorrhea 2 Breast changes 3 Urinary frequency 4 Abdominal enlargement 5 Positive urine pregnancy tes
Answer: 1,2,3 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 a 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 related 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. A 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.
A 40-year-old primigravida is scheduled to have her first abdominal ultrasound. What should the nurse's instructions include? 1 Postpone breakfast until after the test. 2 Drink water until bladder is full. 3 Empty the bladder immediately before the test. 4 Insert a suppository after arising on the day of the test.
Answer: 2 A full bladder raises the uterus above the pelvis, providing better visualization of its contents. It is not necessary to arrive for the test with an empty stomach. The bladder should not be emptied until after the test. It is not necessary to evacuate the bowels before the test.
A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of which month? 1 Fifth month 2 Third month 3 Fourth month 4 Second month
Answer: 2 Because of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the first trimester. Morning sickness usually ends at the end of the third month, not the second month, when the chorionic gonadotropin level falls. It is still present in the second month because of the high level of chorionic gonadotropin, but has usually diminished by the fifth month.
While conducting prenatal teaching, the nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1 Decreased metabolic rate 2 Increased production of estrogen 3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells
Answer: 2 Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. Increased (not decreased) metabolism leads to systemic changes, but does not increase vaginal discharge. The amount of secretion from the Bartholin glands, which lubricates the vagina during intercourse, remains unchanged during pregnancy. There is no additional supply of sodium chloride to the vaginal cells during pregnancy.
A woman's pregnancy has been uneventful, and she has gained 25 lb (11.3 kg). At term her hemoglobin level is 10.6 g/dL (106 mmol/L) and her hematocrit is 31%. What is the physiologic reason for these hemoglobin and hematocrit levels? 1 Infection 2 Hemodilution 3 Nutritional deficits 4 Concealed bleeding
Answer: 2 The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy). Infection does not lead to a lower hematocrit. The history reveals no prenatal problems, and weight gain is adequate. In the absence of other significant signs and symptoms, concealed bleeding is unlikely.
A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? 1 G4 T3 P2 A1 L4 2 G5 T2 P2 A1 L4 3 G5 T2 P1 A1 L4 4 G4 T3 P1 A1 L4
Answer: 3 he acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 A1 L4 indicates that there were five pregnancies; two term births; twins counted as one, not two, preterm births; one abortion; and four living children. G4 T3 P1 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one preterm birth; one abortion; and four living children.
An adolescent at 10 weeks' gestation visits the prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this diet inadequate? 1 The caloric content will result in too great a weight gain. 2 The ingredients in soft drinks and candy can be teratogenic in early pregnancy. 3 The salt in this diet will contribute to the development of gestational hypertension. 4 The nutritional composition of the diet places her at risk for a low-birth-weight infant.
Answer: 4 The diet does not reflect a healthy balance of foods and nutrients, especially protein; adequate nutrition is necessary for the birth of a healthy full-term infant whose weight is appropriate for gestational age. The caloric content of these foods is not high if small amounts are consumed; in addition, this client's weight gain may not be reflective of an adequate weight gain in the developing fetus. No data are available to support the assertion that the ingredients of candy and soft drinks are teratogenic. Unrestricted salt intake does not contribute to the development of gestational hypertension.
