Ch 11: Nursing Care Related to Assessment of Pregnancy Family

b) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them" Pg. 250 The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

1. The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement? a) "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy" b) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them" c) "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully" d) "Sexually transmitted infections are much more common than most people believe"

c) At the level of the umbilicus Pg. 239 By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum.

10. The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? a) At the level of the symphysis pubis b) At the level near the bottom of the sternum c) At the level of the umbilicus d) Three finger-breadths above the umbilicus

b) Clean-catch urine Pg. 238 The first procedure a nurse should ask the client to do is obtain a clean-catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or have an ultrasound performed.

11. Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? a) Ultrasound for fetal measurements b) Clean-catch urine c) Initial blood tests d) Measurement of fundal height

d) The goal of early prenatal care is to optimize the health of the woman and the fetus Pg. 227 Early prenatal classes or first trimester classes include early gestational changes, self care, fetal development and environmental dangers for the fetus, sexuality, birth settings and types of providers, nutrition, rest, exercise, relief measures for discomforts, coping with stress, psychological changes for both woman and her partner, getting the pregnancy off to a good start, availability of prenatal and genetic screening, risk factors for preterm labor and other pregnancy-related conditions, and how to recognize symptoms and what to do if they occur. Although all the answers are essentially correct, optimizing the health of the woman and fetus is the best answer.

12. The nurse is planning a class for nurses learning to teach early prenatal classes. Which statement indicates that teaching has been effective? a) The first prenatal visit should be as soon as the woman misses her period b) Early prenatal care is meant to obtain laboratory work and teach the woman regarding danger signs early in the pregnancy c) Early prenatal care is needed for a healthy newborn d) The goal of early prenatal care is to optimize the health of the woman and the fetus

c) Verify that desired outcomes for identified goals have been met Pg. 258 Evaluating the effectiveness of nursing care given during pregnancy is to look at the nursing diagnosis for the specific client, identify the goals and their desired outcomes for each diagnosis, and see if the desired outcomes are achieved. This may involve using a preprinted survey and interviewing the client. The nursing diagnoses should be established at the beginning to help guide the care for each individual client.

14. The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide? a) Identify the nursing diagnoses for the specific client b) Interview the client on her first postpartum visit about the nursing care she have received c) Verify that desired outcomes for identified goals have been met d) Ask the client to respond to a preprinted survey about nursing care

a) Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Pg. 166 While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.

16. The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record? a) Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling b) Amniocentesis, chorionic villus sampling, fetal nonstress test c) Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate d) Fetal nonstress test, Doppler assessment of fetal heart rate

c) Amniocentesis Pg. 250 Amniocentesis is an invasive procedure whereby a needle is inserted into the amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with Rh(D)-negative blood, since the puncture can allow the seepage of blood and amniotic fluid into the woman's system. She should receive Rho(D) immune globulin after the procedure to protect her and future babies. The CST, NST, and a biophysical profile are noninvasive tests.

18. The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure? a) Biophysical profile b) Nonstress test c) Amniocentesis d) Contraction stress test

c) Gynecoid Pg. A gynecoid, or "female," pelvis has an inlet that is well rounded forward and backward and has a wide pubic arch. This pelvic type is ideal for childbirth. In an android, or "male," pelvis, the pubic arch forms an acute angle, making the lower dimensions of the pelvis extremely narrow. A fetus may have difficulty exiting from this type of pelvis. In an anthropoid, or "ape-like," pelvis, the transverse diameter is narrow; the anteroposterior diameter of the inlet is larger than usual. Even though the inlet is large, the shape of the pelvis does not accommodate a fetal head as well as a gynecoid pelvis. A platypelloid, or "flattened," pelvis has a smoothly curved oval inlet, but the anteroposterior diameter is shallow. A fetal head might not be able to rotate to match the curves of the pelvic cavity.

19. A pregnant client tells the nurse, "My health care provider told me that I have the best type of pelvic shape to deliver my baby vaginally." The nurse interprets this statement as indicating that the client has which pelvic shape? a) Android b) Platypelloid c) Gynecoid d) Anthropoid

c) Alert the RN or health care provider Pg. 228 A client on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one that is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the client. Reassurance is good practice, but not enough in this case. You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.

2. Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do? a) Reassure her that ambivalence is normal b) Give her printed material to read at home c) Alert the RN or health care provider d) Refer her for drug and alcohol counseling

b) Offer to speak with the health care provider and then return her call Pg. 274 Heartburn is a common occurrence in pregnancy; however, the nurse does not authorize medications without speaking with the health care provider first. Omeprazole, an over-the-counter medication, is pregnancy category C (indicating that not enough human studies have been conducted). It would be up to the health care provider to determine acceptable usage.

20. A client at 32 weeks' gestation telephones the health care provider's office asking if omeprazole 20 mg daily is safe to take as she is experiencing heartburn. When reviewing the over-the-counter medication, the nurse notes a pregnancy category C listed. Which would be the nurse's first action? a) Encourage the client to eat less spicy foods and avoid all medications b) Offer to speak with the health care provider and then return her call c) Instruct the client that due to the pregnancy category, this medication is not taken d) Respond that since it is over-the-counter, it is safe

c) "Urinating now will allow easier identification of organs during the examination" Pg. 238 Before a pelvic examination, the nurse should instruct the client to empty the bladder. Doing so makes the examination more comfortable, allows for easier identification of pelvic organs, and provides a urine specimen for laboratory testing. Clean gloves are acceptable as the vagina is not a sterile environment. Though true that the examination may be uncomfortable and that a nurse typically remains in the room with the health care provider, it is not the most important instruction.

21. A pregnant client has come to the clinic for the first prenatal visit. The nurse informs the client that the primary health care provider will do a pelvic examination at this time. Which nursing instruction is most important to include in client teaching at this time? a) "The examination will be uncomfortable but should not be painful" b) "I will remain with you in the room during the examination" c) "Urinating now will allow easier identification of organs during the examination" d) "The primary health care provider will use sterile gloves for the examination"

a) There will be correction officers with the client throughout the appointment Pg. Care considerations and provision of care are the same as for the nonincarcerated population. During a visit with an off-site provider, the corrections officer may be asked to leave the room during the course of the visit to maintain client privacy. The presence of the officer may be required, however, in situations in which the lack of presence may pose a danger to the healthcare staff or the examination space available offers a flight risk. In some cases the officer may be required to maintain direct visual contact of the inmate at all times. Correctional facility medical staff, including nurses and other healthcare providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Typically the client will not be handcuffed or shackled unless they are a danger to others.

23. A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant client. What does the nurse explain is the main difference when an incarcerated client comes to the clinic? a) There will be correction officers with the client throughout the appointment b) There is no difference when incarcerated women come to the clinic c) The client will have follow-up appointments at the prison d) The client will be handcuffed and wearing shackles during the appointment e) The client will receive limited prenatal care

b) "I am unsure who the father of the baby is. I will be raising it alone" Pg. 234-236 While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing Rho(D) immune globulin, and having social issues does not place the client at risk for sexually transmitted infections.

24. The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern? a) "I only want my family to see the baby after it is born" b) "I am unsure who the father of the baby is. I will be raising it alone" c) "I needed Rho(D) immune globulin after my last pregnancy. Will I need it again?" d) "I am not sure if I want to keep the baby. It is a hard decision"

d) Report the finding to the primary health care provider Pg. 243 A herpes simplex 2 viral infection appears as clustered, pinpoint vesicles on an erythematous (reddened) base on the vulva that feels painful when touched or irritated. It is important that these are detected during pregnancy because the presence of herpes lesions on the vulva or vagina at the time of birth may necessitate cesarean birth to prevent exposing the fetus to the virus during passage through the birth canal. This is not the time to be concerned about the status of the father of the baby. Further assessment and follow-up will be completed later. The nurse should already have PPE on their hands. Enlarged lymph nodes may signify an infection but not pinpoint the specifics. At this point, the fetus is at risk of exposure if outside lesions are present.

25. An adolescent who received no prenatal care arrives at the hospital in active labor. Upon examination, the nurse assesses a cluster of pinpoint vesicles with a red base on the vulva; the adolescent asks the nurse to not touch "her rash" because it hurts when touched. At this point, which intervention will the nurse perform next? a) Ask the adolescent if the father of the baby has a rash as well b) Put on gloves and palpate the vulva for enlarged lymph nodes c) Ask the adolescent if this rash is felt internally as well as externally d) Report the finding to the primary health care provider

c) Ask the woman to void for a clean-catch urine specimen Pg. 238 Ask a woman to void for a clean-catch urine specimen before the physical examination, as this will provide a urine specimen for either immediate dipstick or laboratory testing of bacteria, protein, glucose, and ketone determinations; or these can be immediately tested by dipstick analysis. In addition, an empty bladder makes the pelvic examination more comfortable and, by reducing bladder size, allows for easier identification of pelvic organs. There is no need for the woman to perform a breast self-examination, perineal self-examination, or Kegel exercises before the physical examination.

26. A nurse is preparing to perform a physical examination of a pregnant woman at her first prenatal visit. Which of the following actions should the nurse perform before beginning the physical examination? a) Have the woman perform a perineal self-examination b) Have the woman perform a breast self-examination c) Ask the woman to void for a clean-catch urine specimen d) Ask the woman to perform Kegel exercises

d) Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Pg. 229 The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

27. The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? a) Once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth b) Once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth c) Once every 4 weeks for the first 36 weeks, then weekly until the birth d) Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth

c) Helps the lungs remain expanded after the initiation of breathing Pg. 697 Surfactant keeps the alveolar surfaces from sticking together, allowing the lungs to expand and making it easier for the neonate to breathe. Surfactant does not remove mucus or mature the upper airway. It does not effect the breathing pattern, just the effort needed to expand the alveoli.

28. The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse? a) Helps maintain a rhythmic breathing pattern b) Promotes clearing mucus from the respiratory tract c) Helps the lungs remain expanded after the initiation of breathing d) Assists with ciliary body maturation in the upper airways

b) At the umbilicus Pg. 238 At 20 weeks, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.

29. A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location? a) Between the symphysis and umbilicus b) At the umbilicus c) Just below the ensiform cartilage d) Symphysis pubis

b) History of diabetes for 4 years Pg. 233 A diagnosis of diabetes in a pregnant client increases risk for both the client and the infant during pregnancy and requires close monitoring and follow-up. This client's age, exercise history, and history of occasional OTC pain reliever use do not increase pregnancy risk.

3. A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment? a) History of exercising twice a week b) History of diabetes for 4 years c) History of occasional use of OTC pain relievers d) Maternal age of 28 years

a) 4 weeks Pg. 229 The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

30. A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: a) 4 weeks b) 3 weeks c) 1 week d) 2 weeks

a) G = 3, T = 1, P = 0, A = 1, L = 1 Pg. 237 The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

32. A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as: a) G = 3, T = 1, P = 0, A = 1, L = 1 b) G = 2, T = 0, P = 0, A = 0, L = 1 c) G = 4, T = 2, P = 0, A = 0, L = 1 d) G = 1, T = 1, P = 1, A = 0, L = 1

b) Establish a baseline of present health c) Identify women at risk for complications d) Determine the gestational age of the fetus f) Monitor for fetal development and maternal well-being Pg. 228 The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

33. A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of prenatal care? Select all that apply. a) Maximize the risk of possible complications b) Establish a baseline of present health c) Identify women at risk for complications d) Determine the gestational age of the fetus e) Increase the business of the clinic f) Monitor for fetal development and maternal well-being

a) Wash the nipples with clean water only Pg. 259 She should use only clean water to wash the nipples. The use of any soap will dry the nipples and can lead to cracking.

34. The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care? a) Wash the nipples with clean water only b) Use hot water and a mild soap to keep the nipples clean c) Wash the nipples with a deodorant soap to keep them clean and help toughen them d) Use an antibacterial soap and cool water to keep the nipples clean

a) Watch it and report if heavy increase in bleeding Pg. 251 During the third trimester, if the provider completes a vaginal exam it can be normal to have a small amount of spotting. If the bleeding becomes active or increases, the client needs to be seen immediately. Chadwick sign is a change of color in the vaginal area. The loss of the mucus plug would lead to a much greater amount of blood.

36. The nurse takes a call from a worried client who was seen several hours earlier for her 35-weeks' gestation visit, which included a pelvic examination. Which instruction should the nurse prioritize if the client is reporting a small amount of vaginal spotting? a) Watch it and report if heavy increase in bleeding b) Return right away c) The cervical mucus plug may have been expelled d) The bleeding, called Chadwick sign, is a normal part of pregnancy

a) 2 previous pregnancies, 2 live births, and currently pregnant Pg. 237 A woman who has had two previous pregnancies and currently pregnant (gravida 3) and has given birth to two live neonates (para 2) is gravida 3, para 2 using the GP system.

37. A nurse is reviewing the obstetric history of a pregnant woman who has come to the clinic for a visit. The history reveals that the woman is "gravida 3, para 2." Which interpretation by the nurse would be appropriate? a) 2 previous pregnancies, 2 live births, and currently pregnant b) 3 previous pregnancies and 2 live births c) 2 previous births and 3 miscarriages d) 3 previous pregnancies and 2 live births

d) Facial edema Pg. 241 Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

6. Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy? a) A hyperpigmented rash over the maxillary region bilaterally b) Nosebleeds c) Generalized hair loss d) Facial edema

a) 20 cm Pg. 191 Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.

7. The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? a) 20 cm b) 24 cm c) 16 cm d) 12 cm

a) Stretching and breathing exercises such as yoga Pg. 260-261 It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.

8. The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? a) Stretching and breathing exercises such as yoga b) All activities that the client does in a prepregnant state c) Relaxing activities such as hot baths and jacuzzis d) High-impact movements enabling less time in the activity

d) "Taking gentle enemas no more frequently than once a week is acceptable" Pg. 289 Constipation is a common source of concern for many women in pregnancy. It results from the slowing of intestinal peristalsis and also as a side effect of iron administration. Steps such as increasing fluid intake, increasing dietary fiber, and exercising are beneficial in reducing constipation. Weekly enemas during the pregnancy are not advisable. Enemas can be habit forming and do not correct the causes of the constipation being experienced.

9. A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction? a) "Exercise such as walking daily helps increase my bowel movements" b) "Adding more vegetables to my diet will be helpful" c) "Increasing my water intake will aid in reducing my constipation" d) "Taking gentle enemas no more frequently than once a week is acceptable"

b) G3, T0, P1, A1, L1 Pg. 237 The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.

13. A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? a) G3, T1, P0, A2, L1 b) G3, T0, P1, A1, L1 c) G2, T1, P2, A1, L2 d) G2, T0, P1, A1, L1

a) Fundal height measurement Pg. 240 On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the client's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.

15. When assessing a client at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? a) Fundal height measurement b) Hemoglobin and hematocrit c) Fetal ultrasound d) Urine for culture

b) December 30 Pg. 187-188 Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

22. The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: a) December 16 b) December 30 c) January 30 d) November 23

d) Multiple fetal pregnancy Pg. 191 The fundus typically is at the level of the umbilicus at 20 weeks' gestation. Therefore the fundal height is greater than that which is expected, suggesting possible multiple gestation, polyhydramnios, fetal anomalies, or macrosomia. Smaller than expected measurements would suggest intrauterine growth retardation or possibly inadequate amount of amniotic fluid. Urinary retention would displace the uterus.

31. The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation? a) Urinary retention b) Deficient amniotic fluid c) Intrauterine growth retardation d) Multiple fetal pregnancy

d) 10 to 12 weeks Pg. 241 Fetal heart sounds can be heard through a Doppler at 10 to 12 weeks and through a regular stethoscope at 18 to 20 weeks.

35. A client at 6 weeks' gestation asks if she can listen to the fetal heart sounds. The nurse informs the client that fetal heart sounds cannot be heard with a Doppler until when? a) 24 weeks b) 18 to 20 weeks c) 8 weeks d) 10 to 12 weeks

a) Chew gum e) Suck on hard candies Pg. 295 Ptyalism or excess salivation may be relieved by chewing gum or sucking on hard candies. Many of the interventions used to relieve nausea and vomiting may also work for ptyalism.

4. A client at 10 weeks' gestation is complaining of ptyalism over the past 2 weeks. What intervention would the nurse recommend to this client? Select all that apply. a) Chew gum b) Wear a panty liner c) Eat a large, protein rich meal in the evening d) Use saline nasal spray e) Suck on hard candies

b) At the level of the umbilicus Pg. 238 In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

5. A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client? a) At the top of the symphysis pubis b) At the level of the umbilicus c) At the xiphoid process d0 Halfway between the symphysis pubis and the umbilicus

d) Frequent rest periods Pg. 262-263 It is common to have a client work until she goes into labor as long as she has had a low-risk pregnancy. Frequent rest periods are stressed, if possible, as the client progresses throughout the work day. The other options are good suggestions for any client at the end of pregnancy.

17. Which information is most important in order to decrease the risk of complications if the client decides to work until her due date? a) Eat light meals b) Flat shoes c) Adequate sleep d) Frequent rest periods