Chapter 13

D. Identifies potential nutritional problems or complications of pregnancy Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. Excessive adipose tissue may occur with excess weight gain but is not the reason for monitoring the weight gain pattern. The pattern of weight gain is not affected by cultural influences. It is important to monitor the pattern of weight gain for the developing complications.

Which is the most important reason for evaluating the pattern of weight gain in pregnancy? a. Prevents excessive adipose tissue deposits b. Determines cultural influences on the woman's diet c. Assesses the need to limit caloric intake in obese women d. Identifies potential nutritional problems or complications of pregnancy

Rubella titer, 1:6 A rubella titer of less than 1:8 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period because administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months. The lab values for WBCs, platelets, and hematocrit/hemoglobin are within the expected range for pregnant women.

Which laboratory result would be a cause for concern if exhibited by a client at her first prenatal visit during the second month of her pregnancy?

B. Headaches that do not respond to usual therapy. C. Rupture of membranes D. Vaginal bleeding

Which o f the following s igns and symptoms should a woman report immediately to her health care provider? Choose all that apply:

"This is something that we ask everyone. Do you feel safe in your current living environment and relationships?

The student nurse is learning that is is recommended to screen for domestic violence in the first prenatal visit for all clients. The instructor has explained how to communicate and ask questions that are personal, so which question would be the best stated for t he student nurse to ask ?

Pre-term labor

These may cause what? Maternal: GH,DM heat or renal disease, cervical insufficiency, PROM, maternal infection​ Fetal: fetal infection, multiple pregnancy, and hydramnios​ Placental: Previa or abruptio ​

D. Orange juice A vitamin C source may increase the absorption of iron. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy.

To increase the absorption of iron in a pregnant client, with what should an iron preparation be given? a. Tea b. Milk c. Coffee d. Orange juice

Dorsiflex the foot.

To relieve a leg cramp, what should the client be instructed to perform?

B. January 19 Nägele's rule subtracts 3 months from the month of the last menstrual period (month 4 month - 3 = January) and adds 7 days to the day that the last menstrual period started (April 12 + 7 days = April 19), so the correct answer is January 19.

Use Nägele's rule to determine the EDD (estimated day of birth) for a client whose last menstrual period started on April 12. a. February 19 b. January 19 c. January 21 d. February 7

deviation

Vaginal bleeding during pregnancy is always a ________ from the normal, is always potentially serious, may occur at any point during pregnancy, and is always frightening.​

Investigated

Vaginal bleeding must always be carefully ___ because it can impair both the pregnancy and woman's life

HELLP syndrome

Very serious results in a 24% mortality rate and an infant mortality rate as high as 35%. Pt has proteinuria, edema, increased BP, nausea, epigastric pain, general malaise, right upper quadrant tenderness from the liver inflammation. Lab work reveals hemolysis of the red blood cells, thrombocytopenia, and elevated liver enzymes, and serum aspartate aminotransferase with affects hemorrhage and necrosis of the liver. ​

c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. Providing factual information based on physiologic mechanisms is the best option. Although having the client write down her concerns is reasonable, the nurse should not refer this conversation to the physician but rather address the client's specific concerns. Switching to a high-iron diet will not correct this condition. This physiologic pattern occurs during pregnancy as a result of hemodilution from excess blood volume. Iron medication is not indicated for correction of this condition. There is no need to contact the physician for a prescription.

What is the best explanation that you can provide to a pregnant client who is concerned that she has "pseudo anemia" of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated. b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. d. Contact the physician and get a prescription for iron pills to correct this condition

Provides adequate perfusion of the placenta The primary function of the increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.

What is the reason for vascular volume increasing by 40% to 60% during pregnancy?

D. 25 to 35 lb. A weight gain of 25 to 35 lb. is believed to reduce intrauterine growth restriction that may result from inadequate nutrition, and also allows for variations in individual needs. There is no precise weight gain appropriate for all women. A 10- lb weight gain is not sufficient to meet the needs of the pregnancy. A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. A 20- to 25-lb weight gain is recommended for women who are overweight before the pregnancy.

What is the recommended weight gain during pregnancy for a client who begins pregnancy at a normal weight? a. 10 to 15 lb. b. 15 to 20 lb. c. 20 to 25 lb. d. 25 to 35 lb.

Assess and monitor the fetus Evaluate the placenta

What should you do when bleeding occurs in pregnancy?

Chew gum or suck on lozenges between meals Some women experience ptyalism, or excessive salivation. The cause of ptyalism may be decreased swallowing associated with nausea or stimulation of the salivary glands by the ingestion of starch. Small frequent meals and use of chewing gum and oral lozenges offer limited relief for some women. All other options include recommendations for pregnant women; however, they do not address ptyalism.

When a pregnant woman develops ptyalism, what should the nurse advise?

2nd trimester or 3rd trimester

When do placenta previa, placental abruption, and the gestational trophoblastic disease usually occur?

Primigravida

When documenting a client encounter, what term will the nurse use to describe the woman who is in the 28th week of her first pregnancy?

Massage uterine fundus if possible Apply anti-shock garments - Monitor for hypovolemic shock (Increased pulse, decreased BP, increased RR, cold clammy skin, dizziness)

When is bleeding does not stop what should you do?

B. Review the client's current dietary intake. The first action should be to assess the client's current dietary pattern and practices because instruction should be geared to what she already knows and does. Teaching the food guide MyPlate is important but not the first action when planning a diet with a pregnant client. Limiting intake of fatty foods is important in a pregnant client's diet but not the first action. Cautioning about excessive fat soluble vitamins is important but not the first action.

When planning a diet with a pregnant client, what should the nurse's first action be? a. Teach the client about MyPlate. b. Review the client's current dietary intake. c. Instruct the client to limit the intake of fatty foods. d. Caution the client to avoid large doses of vitamins, especially those that are fat-soluble.

D. In the second trimester Vitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period.

When should iron supplementation during a normal pregnancy begin? a. Before pregnancy b. In the first trimester c. In the third trimester d. In the second trimester

Isoimmunization

Whenever a placenta is dislodged at any point during the pregnancy. If the fetus is RH positive and the mother is RH neg enough fetal blood may enter the maternal circulation and cause isoimmunization or production of antibodies against RH positive blood. So the next baby could be destroyed in utero, therefore all women RH neg should receive the RH immune globin to prevent the buildup of antibodies.

a. Quickening b. Amenorrhea e. Chadwick's sign Quickening, amenorrhea, and Chadwick's sign are presumptive signs of pregnancy. Ballottement and Goodell's sign are probable signs of pregnancy.

Which are presumptive signs of pregnancy? (Select all that apply.) a. Quickening b. Amenorrhea c. Ballottement d. Goodell's sign e. Chadwick's sign

Abdominal pain Abdominal pain may indicate ectopic pregnancy (if early), worsening preeclampsia, or abruptio placentae. Ankle edema in the afternoon is a normal finding at this stage of the pregnancy. Backaches while standing is a normal finding in the later stage of pregnancy. Shortness of breath is an expected finding at 35 weeks.

Which complaint made by a client at 35 weeks of gestation requires additional assessment?

a. Diet consisting of processed foods d. Last trimester of pregnancy e. Decreased venous return Processed foods, which are high in sodium content, can contribute to edema formation. As the pregnancy progresses, because of the weight of the uterus, compression takes place, leading to decreased venous return and an increase in edema formation. A decrease in colloid osmotic pressure would contribute to edema formation and fluid shifting. Hemodilution would also lead to edema formation.

Which factors contribute to the presence of edema in the pregnant client? (Select all that apply.) a. Diet consisting of processed foods b. Hemoconcentration c. Increase in colloid osmotic pressure d. Last trimester of pregnancy e. Decreased venous return

A. Vasoconstriction Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism.

Which is the common effect of both smoking and cocaine use on the pregnant client? a. Vasoconstriction b. Increased appetite c. Increased metabolism d. Changes in insulin metabolism

2, 1 She has had two pregnancies (gravida 2); para refers to the outcome of the pregnancy rather than the number of infants from that pregnancy. She is pregnant now, so that would make her a gravida 2. She is para 1 because she had one pregnancy that progressed to the age of viability.

Which is the gravida and para for a client who delivered triplets 2 years ago and is now pregnant again?

Increase in serum creatinine level With pregnancy, one would expect the serum creatinine and BUN levels to decrease. An elevation in the serum creatinine level should be investigated. With pregnancy, the GFR increases because of increased renal blood flow and is thus a normal expected finding. A decrease in the blood urea nitrogen level and mild proteinuria are expected findings in pregnancy

Which of these findings would indicate a potential complication related to renal function during pregnancy? a. Increase in glomerular filtration rate (GFR) b. Increase in serum creatinine level c. Decrease in blood urea nitrogen (BUN) d. Mild proteinuria

D. Decreased motility in the intestines Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines. Decreased absorption of water would not cause constipation.

Which physiologic event may lead to increased constipation during pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines

b. Cardiac output increases during pregnancy Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to client positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy.

Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases. b. Cardiac output increases during pregnancy. c. Blood pressure remains consistent independent of position changes. d. Maternal vasoconstriction occurs in response to increased metabolism.

D. Prolonged emptying time Prolonged emptying time is seen during pregnancy and may lead to the development of gallstones. In pregnancy, there is a twofold to fourfold time increase in alkaline phosphatase levels as compared with those in nonpregnant woman. During pregnancy, a decrease in albumin level and total protein are seen as a result of hemodilution. Gallbladder tissue becomes hypotonic during pregnancy.

Which physiologic findings are seen with respect to gallbladder function that might lead to the development of gallstones during pregnancy? a. Decrease in alkaline phosphatase levels compared with nonpregnant women b. Increase in albumin and total protein as a result of hemodilution c. Hypertonicity of gallbladder tissue d. Prolonged emptying time

Use Tums or Alka mints to obtain relief, as directed by the health care provider.

Which suggestion is appropriate for the pregnant client who is experiencing heartburn?

These occur throughout pregnancy, but you may not feel them until the third trimester.

While providing education to a primiparous client regarding the normal changes of pregnancy, what is important for the nurse to explain about Braxton Hicks contractions?

Have the client turn to her left side and recheck her blood pressure in 5 minutes.

While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

The conditions of the expectant mother and fetus can be monitored. This routine allows for monitoring maternal health and fetal growth and ensures that problems will be identified early. All problems cannot be eliminated because of prenatal visits, but they can be identified. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy.

Why should a woman in her first trimester of pregnancy expect to visit her health care provider every 4 weeks?

Fundal height is below the umbilicus. Based on gestational age (20 weeks), the fundal height should be at the umbilicus. This finding is abnormal and warrants further investigation about potential risk. With subsequent pregnancies, multiparas may not perceive Braxton Hicks contractions as being evident compared with their initial pregnancy. Cervical changes such as Goodell's and Chadwick's signs should be present and are considered a normal finding. Increased vaginal secretions are normal during pregnancy as a result of increased vascularity.

You are performing assessments for an obstetric client who is 5 months pregnant with her third child. Which finding would cause you to suspect that the client was at risk?

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache BP < 140/90

Relaxing in a hot tub for 30 minutes a day, several days a week Pregnant women should avoid activities that might cause hyperthermia. Maternal hyperthermia, particularly during the first trimester, may be associated with fetal anomalies. She should not be in a hot tub for more than 10 minutes at less than 100 F. Sexual intercourse is generally safe for the healthy pregnant woman; moderate exercise during pregnancy can strengthen muscles, reduce backache and stress, and provide a feeling of well-being; working during pregnancy is acceptable as long as the woman is not continually on her feet or exposed to environmental toxins and industrial hazards

Which of the client health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy? a. Sexual intercourse two or three times weekly b. Moderate exercise for 30 minutes daily c. Working 40 hours a week as a secretary in a travel agency d. Relaxing in a hot tub for 30 minutes a day, several days a week

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

Septic Abortion

is an abortion complicated by an infection- fever abdominal pain, uterus feels tender to palpation. If this is left untreated it can lead to toxic shock syndrome, septicemia, kidney failure and death.​

This is due to an increase of blood volume.

A client in the prenatal clinic is complaining of episodes of dizziness when sitting up after lying supine for some time. Which response by the nurse explains this change during pregnancy?

c. 4, 2 She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion. Because she is currently pregnant, she is classified as a gravida 4. Gravida 4 is correct, but she is para 2; the pregnancy that was terminated at 8 weeks is classified as an abortion. Because she is currently pregnant, she would be classified as a gravida 4, not 3.

A client is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Which are her gravida and para?

Evaluate vital signs Monitor the amount of vaginal bleeding Evaluate fetal heart tones

A client who is 32 weeks pregnant is being monitored in the Antepartum unit for pregnancy induced hypertension (gestational hypertension). She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing interventions should be included in the care of this client? (select all that apply)

B. Death before or after birth Smoking during pregnancy increases the risk for spontaneous abortion, low birth weight, abruptio placentae, placenta previa, preterm birth, perinatal mortality, and SIDS. Smoking does not appear to cause congenital anomalies, hypoglycemia, or withdrawal syndrome.

A client who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition? a. Congenital anomalies b. Death before or after birth c. Neonatal hypoglycemia d. Neonatal withdrawal syndrome

Possible IUGR and the nurse should identify risk factors and notify the physician.

A client with a gestational age of 32 weeks arrives at the clinic for a routine prenatal visit. In identifying fetal well being, the nurse knows she must measure fundal height, fetal heart tones and fetal movement. The nurse finds the fundal height to be 28 cm and fetal heart tones at 115 bpm, and mother relates that fetal movement has slowed. What may the nurse conclude with this finding?

March 17 To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. March is the correct month, but instead of adding 7 days, 17 days were added. April 17 is subtracting 2 months instead of 3.

A client's last menstrual period was June 10. What is her estimated date of birth (EDD)?

They can be effective for many couples, but they require motivation.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods. (Natural family planning, FAM's) What is the nurse's most appropriate response?

Neural tube defects

A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency?

A. Client has been through active labor B. Client has one living child C. Client has had two prior pregnancies D. Client has experienced no preterm labor E. Client has delivered one newborn at term

A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's health record includes this data: G3, T1, P0, A1, L1. How should the nurse interpret this information?

Oral contraceptives should be taken the same time each day

A nurse instructs a 20-year-old female college student about oral contraceptives. After the teaching session, the nurse confirms that the client understands the information when she makes which of the following statements?

Ambulate twice daily

A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification?

Unilateral abdominal pain

A nurse is caring for a client who has a possible ectopic pregnancy at 8 weeks gestation. Which of the following manifestations should the nurse expect to identify as consistent with this diagnosis?

Painless red vaginal bleeding

A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?

Rhogam prevents the formation of Rh antibodies in mothers who are Rh negative

A nurse is caring for a client who is prescribed Rho immune globulin standard dose IM (Rhogam). The nurse should understand the action of this medication as which of the following?

Calcium gluconate

A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected?

Intrauterine growth restriction

A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications?

Ingestion of nonfood substances The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting.

A nurse is conducting a prenatal nutritional education class for a group of nursing students. Which should the nurse include as the definition of pica? a. Iron deficiency anemia b. Intolerance to milk products c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

Shortness of breath

A nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider. The nurse determines the client understands the teaching when the client states the need to report which of the following?

"I plan to drink more orange juice while taking this pill."

A nurse is reviewing a prescription for ferrous sulfate (iron supplementation) with a client who is at 12 weeks gestation. Which of the following statements by the client indicates understanding of the teaching?

D. Complex carbohydrates Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. Fats provide 9 calories in each gram, in contrast to carbohydrates and proteins, which provide only 4 calories in each gram. Fiber is supplied mainly by the complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients.

A nurse is teaching a nutrition class to a group of pregnant clients. The nurse should include that the major source of nutrients in the diet of a pregnant woman should be composed of which? a. Fats b. Fiber c. Simple sugars d. Complex carbohydrates

D. Let the client know that this is a common finding that occurs during pregnancy. This condition is known as chloasma or melasma (mask of pregnancy) and is a result of pigmentation changes relative to hormones. It can be exacerbated by exposure to the sun. There is no need to refer to a dermatologist. Intake of foods is not associated with exacerbation of this process. There is no need for a C&S to be taken. The client should be assured that this is a normal finding of pregnancy.

A pregnant client notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? a. Refer the client to a dermatologist for further examination. b. Ask the client if she has been eating different types of foods. c. Take a culture swab and send to the lab for culture and sensitivity (C&S). d. Let the client know that this is a common finding that occurs during pregnancy.

a. Tetanus c. Influenza d. Hepatitis A and B Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer to women who have a risk for contracting or developing the disease. Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

A pregnant client reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this client receive? (Select all that apply.) a. Tetanus b. Varicella c. Influenza d. Hepatitis A and B e. Measles, mumps, rubella (MMR)

D. Green leafy vegetables Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate.

A pregnant client's diet may not meet her need for folate. What is a good source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

Hepatitis B In general, immunizations with live virus vaccines (e.g., measles, mumps, rubella, varicella, smallpox) are contraindicated during pregnancy because they may have teratogenic effects on the fetus. Inactivated vaccines are safe and can be used in women who have a risk of developing diseases such as tetanus, hepatitis B, and influenza.

A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations, which will the nurse administer?

D. eat small, frequent meals (every 2 to 3 hours)

A pregnant woman experiencing nausea and vomiting. What action can she take?

4-1-2-0-2 Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as T: 1 = term birth at 41 weeks of gestation (son) P: 2 = preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) A: 0 = abortion: none occurred L: 2 = living children: her son and her daughter.

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the five-digit system to describe this woman's current obstetric history, what should the nurse record?

"It is the best time to find any conditions that could have a negative effect on a pregnancy."

A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best?

"It refers to the bluish color of the cervix in pregnancy."

.A client notices that the health care provider writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. Which is the nurse's best response?

D. 31011 Because this is a prenatal history, the client is pregnant. Gravida is the number of times the uterus has been pregnant, which in this case is three. The patient reported one Term birth, no Preterm births, one Abortion or miscarriage, and presumably one Live child.

.A nurse is conducting a prenatal history with a patient who is new to the clinic. The woman reports that she had one healthy baby at term, and a miscarriage at 8 weeks. What will the nurse document as the patient's GTPAL? a. 21011 b. 20111 c. 30111 d. 31011

a. Report watery vaginal discharge. b. Report puffiness of the face or around the eyes. d. Report visual disturbances, such as spots before the eyes. Watery vaginal discharge could mean that the membranes have ruptured. Puffiness of the face or around the eyes and visual disturbances may indicate preeclampsia or eclampsia. These three signs should be reported. Bloody show as labor starts may mean the mucous plug has been expelled. One of the earliest signs of labor may be bloody show, which consists of the mucous plug and a small amount of blood. This is a normal occurrence. Up to 70% of women have dependent edema during pregnancy. This is not a sign of a pregnancy complication.

.The nurse is teaching a pregnant client about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.) a. Report watery vaginal discharge. b. Report puffiness of the face or around the eyes. c. Report any bloody show when you go into labor. d. Report visual disturbances, such as spots before the eyes. e. Report any dependent edema that occurs at the end of the day.

"Many women have benign lumps and bumps in their breasts. However to make sure that it is benign, you should come in for an examination by your physician

A 20 year -old client calls the clinic to report that she has found a lump in her breast. The nurse's best response to her is which of the following?

"HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer.

A 25-year-old single female comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" What is your best response?

Terbutaline (Brethine) Pitocin Betamethasone

A 30 week gestational age pregnant client presents to the labor suite with complaints of contractions and pressure. What medications can the nurse expect the provider to order for administration?

Place on a fetal monitor Position the patient in the supine position to facilitate accurate fetal monitoring

A 34 week pregnant woman is experiencing preterm labor. The nurse will provide the following interventions for her client?

B. 340 more calories a day The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy. 500 calories are more than the recommended calories for pregnancy.

A client in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What should the nurse's response be? a. 180 more calories a day b. 340 more calories a day c. 452 more calories a day d. 500 more calories a day

"It may be due to changes in hormones." Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Gastric secretions decrease, but this is not the main cause of nausea and vomiting

A client in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" What is the nurse's best response?

"If you are traveling by car stop to walk every 1 to 2 hours." Car travel is safe during normal pregnancies. Suggest that the woman stop to walk every 1 to 2 hours so she can empty her bladder. Walking also helps decrease the risk of thrombosis that is elevated during pregnancy. Seat belts should be worn throughout the pregnancy. Instruct the woman to fasten the seat belt snugly, with the lap belt under her abdomen and across her thighs and the shoulder belt in a diagonal position across her chest and above the bulge of her uterus. Travel by plane is generally safe up to 36 weeks if there are no complications of the pregnancy, so only travelling by car is an inaccurate statement.

A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give about safe travel during pregnancy?

Increased pulse rate

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

placental abruption

Dark red vaginal bleeding what do you think

D. G5 T1 P1 A2 L2 This client is in her fifth pregnancy, which is G5, she had one viable term infant (between 38 and 42 weeks' gestation), which is T1, she had one viable preterm infant (between 20 and 37 weeks' gestation), which is P1, two spontaneous abortions (before 20 weeks' gestation), which is A2, and she has two living children, which is L2.

Determine the obstetric history of a client in her fifth pregnancy who had two spontaneous abortions in the first trimester, one infant at 32 weeks' gestation, and one infant at 38 weeks' gestation. a. G5 T1 P2 A2 L 2 b. G5 T1 P1 A1 L2 c. G5 T0 P2 A2 L2 d. G5 T1 P1 A2 L2

dysmenorrhea

During her annual gynecologic check up a 17 year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as?

What HELLP syndrome stands for

H-Hemolysis leads to anemia​ E-elevated ​ L -Liver enzymes lead to epigastric pain​ L -Low​ P -platetes lead to abnormal bleeding/clotting​

Disseminated Intravascular Coagulopathy​

Hematological illness that is secondary to an underlying disease, such as sepsis, hypoxemia, major trauma with severe tissue injury, malignancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, extensive burns, or severe viral infection ...in the case of pregnancy placenta abruption.​

Drug abuse Hypertension Smoking

Intrauterine growth restriction is the result of poor placental perfusion. What pregnancy risk factors may contribute to intrauterine growth restriction?

Braxton Hicks contractions

Irregular contractions that can cause some discomfort throughout pregnancy but are especially noticeable in the third trimester are?

Yes - Uterine rupture? No - Placenta previa?

Light red bleeding with and without pain what do you think?

Prevent and treat seizures

Magnesium sulfate is given to a pregnant client with pre eclampsia and eclampsia for which of the following reasons?

C. Non-steroidal anti- inflammatory drugs (NSAIDS)

Management of primary dysmenorrhea often requires a multifaceted approach. What is the optimal pharmacological therapy for pain relief when caring for a client with this condition?

dilated to 4, gestational hypertension, prolonged rupture of membranes, hemorrhage, abruption placenta, fetal complications or fetal death​

No attempt to stop pre-term labor if

preterm birth

Occurs in 9-11% of all pregnancies. It is responsible for almost 2/3rds of all infant deaths in the neonatal period​ ​

dilution of hemoglobin concentration. When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is increased production of erythrocytes during pregnancy.

Physiologic anemia often occurs during pregnancy because of:

20

Placental abruptions is a premature separation of the placenta from the uterine wall after the ___ week of gestation and before the fetus is delivered

Blood type and Rh factor Group Beta Strep vaginal culture Amniocentesis

Prenatal testing is done to identify health issues that may interfere with the developing fetus. Within the first trimester what lab tests are normally obtained? (select all that apply

Macrosomia

Screening at 24 weeks gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. What does the nurse identify as the greatest risk for the fetus?

A. provides oxygen to the lungs B. cushioning of the baby from minor trauma C. temperature control D. nutrition for the baby E. permits free movement of the baby

The amniotic fluid has many functions and we know that amniotic fluid is necessary for fetal well- being. Please select the purpose of the fluid for fetal well -being. Select all that apply.

B. 2500 The increase for a breastfeeding client is 500 calories above her recommended pre pregnancy caloric intake. 2300 calories are not enough to meet her needs. 2750 calories may be too many calories and may lead to weight gain. 3000 calories are too many for this client and will lead to weight gain

The breastfeeding client who's recommended pre pregnancy caloric intake was 2000 calories per day would need how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000

"This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix." Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish-purple color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. Although Chadwick's sign occurs with hyperemia (congestion with blood), the sign does not signify an increased risk of blood clots. The softening of the cervix is called Goodell's sign, not Chadwick's sign. Although the formation of a mucous plug protects from infection, it is not called Chadwick's sign.

The client has just learned she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the client asks the nurse what this means, how should the nurse respond?

C. The IUD will need to be removed to avoid complications such as miscarriage or infection. Pregnancy with an intrauterine device (IUD) in place is unusual but it can occur and cause complications such as spontaneous abortion and infection. A therapeutic abortion is not indicated unless infection occurs

The client with an IUD has a positive pregnancy test. When planning care, the nurse will base decisions on which anticipated action? a. A therapeutic abortion will need to be scheduled because fetal damage is inevitable. b. Hormonal analyses will be done to determine the underlying cause of the c. The IUD will need to be removed to avoid complications such as miscarriage or infection. d. The IUD will need to remain in place to avoid injuring the fetus.

D. October 27 Nägele's rule is often used to establish the EDD. This method involves subtracting 3 months from the date the LNMP began and then adding 7 days

The clinic nurse confirms that a patient is pregnant. She reports to the nurse that she has regular periods, and the first day of her last period was on January 20. Using Nägele's rule, what due date will the nurse relay to the patient? a. September 23 b. September 27 c. October 23 d. October 27

. normal pregnancy values for the third trimester

The clinic nurse reviews the complete blood count results of a 30-year-old woman who is now 33 weeks' gestation. The patient's hemoglobin value is 11.2 g/dL and her hematocrit is 38%. How does the clinic nurse interprets these findings?

C. "Have you felt a fluttering sensation in your lower pelvic area yet?" Quickening is the first maternal sensation of fetal movement and is often described as a fluttering sensation. Quickening is detected at approximately 20 weeks in the primigravida and as early as 16 weeks in the multigravida. The fundus is at the umbilicus at 20 weeks' gestation. Lightening is associated with the descent of the fetal head into the maternal pelvis and is associated with improved lung expansion. Lightening occurs approximately 2 weeks before birth in the primipara. Fetal heart tones can be detected by Doppler as early as 9 to 12 weeks of gestation. Pica is the craving for non-nutritive substances such as chalk, dirt, clay, or sand. It can develop at any time during pregnancy. It can be associated with malnutrition and the health care provider should monitor the client's hematocrit/hemoglobin, zinc, and iron levels.

The health care provider reports that the primigravida's fundus can be palpated at the umbilicus. Which priority question will the nurse include in the client's assessment? a. "Have you noticed that it is easier for you to breathe now?" b. "Would you like to hear the baby's heartbeat for the first time?" c. "Have you felt a fluttering sensation in your lower pelvic area yet?" d. "Have you recently developed any unusual cravings, such as for chalk or

Eclampsia

The mortality rate can be as high as 20%. Fetal prognosis is poor due to hypoxia possibly cause by the seizure with consequent fetal acidosis. Premature separation of the placenta from extreme vasospasm occurs. ​ - the mother has passed into the stage when cerebral edema is so acute a grand mal (tonic-clonic) seizure or coma has occurred. ​

10-12 weeks gestation

The normal parameter of Fetal heart tones is 110 - 160 and can be heard by a doppler as early as?

In a side-lying position

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping in what position?

A. Ask the patient when she last felt fetal movement. Between 16 and 36 weeks, fundal height measurement corresponds with the weeks of gestation. The patient was last at the clinic at 23 weeks and would be rescheduled to return at 27 weeks, or in 4 weeks. The fundal height is 3 cm less than it should be, so the nurse is concerned about fetal well-being. Fetal movement is one of the first indicators of fetal well-being. If the patient's bladder is full, the fundal height measurement will surpass the expected finding. Weight gain can be an indicator of well-being, nutritional status, and excess fluid volume. It is not as reliable an indicator as fetal movement for well-being. DTRs are assessed routinely to assess for hyperreflexia associated with gestational or pregnancy-induced hypertension.

The nurse is assessing a patient during a routine prenatal visit. Her pregnancy has been unremarkable, and at her last visit her fundal height measurement was 23 cm. The nurse measures the patient's fundal height at 24 cm. What is the next nursing action? a. Ask the patient when she last felt fetal movement. b. Palpate the patient's bladder to determine if it is full. c. Review the patient's chart for her pattern of weight gain. d. Assess the patient's deep tendon reflexes (DTRs) bilaterally at the patella.

At or near the umbilicus

The nurse is palpating the uterus of a client who is 20 weeks pregnant to measure fundal height. Identify where the nurse will find the uterine fundus?

a. Suck on hard candy. d. Drink fluids frequently but separate from meals. e. Eat crackers or dry cereal before arising in the morning. A client experiencing nausea and vomiting should be taught to suck on hard candy, drink fluids frequently but separately from meals, and eat crackers, dry toast, or dry cereal before arising in the morning. Prenatal vitamins should be taken at bedtime because they may increase nausea if taken in the morning. Before taking herbal tea, the client should check with her health care provider.

The nurse is planning care for a client in her first trimester of pregnancy who is experiencing nausea and vomiting. Which interventions should the nurse plan to teach this client? (Select all that apply.) a. Suck on hard candy. b. Take prenatal vitamins in the morning. c. Try some herbal tea to relieve the nausea. d. Drink fluids frequently but separate from meals. e. Eat crackers or dry cereal before arising in the morning.

B. 2 weeks From 29 to 36 weeks, routine prenatal assessment is every 2 weeks. If the pregnancy is high risk, the patient will see the health care provider more frequently.

The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks gestation. When will the nurse schedule the next prenatal visit? a. 1 week b. 2 weeks c. 3 weeks d. 4 weeks

September 15 Nägele's rule is often used to establish the EDD. This method involves subtracting 3 months from the date the LNMP began and adding 7 days. The incorrect responses add months instead of subtracting months and subtract days instead of adding days.

The patient reports that the first day of her last normal menstrual period was December 8. Using Nägele's rule, what date will the nurse identify as the estimated date of birth? a. March 1 b. March 15 c. September 1 d. September 15

18-20 weeks

Fetal movement that is noted by the mother is a very important assessment factor to determine fetal well being. If the nurse is to ask the client if she has "felt her baby move", when is the best time for a primigravid client to note the first fetal activity?

Preeclampsia Risk Factors​

-Primagravida ​ - Younger or older maternal patient​ - History of severe preeclampsia ​ - Recurrence is 65% if it occurred before 30 weeks​ 25 % if it occurred in the last trimester of previous pregnancy​ - Family history​ - Preexisting vascular disease (diabetes, chronic HTN, renal disease)​ - multiple gestation​ - obesity (three-fold increase in risk)​ - periodontal disease​ African-American descent.​

recurrent pregnancy loss

(habitual aborters) 3 spontaneous miscarriages that occurred at the same gestational age​

Contractions (Assessment)

- Duration (length from beginning to end)​ - Frequency (time between start of one contraction to the start of next contraction)​ - Intensity (palpate uterus)​ - Resting tone (palpate uterus)​

"I'll make sure your health care provider is informed of your concern." The patient is experiencing classic signs of physiologic anemia, or an increase in the amount of plasma resulting in a dilution of circulating red blood cells (RBCs). Red blood cell production will continue to increase throughout pregnancy, with a resulting resolution in physiologic anemia. The health care provider will likely order a complete blood count to verify this. The anemia is physiologic and not chronic because there is no decrease in circulating RBCs. The absence of proteinuria and glucosuria is reassuring, but these findings are not correlated with fatigue. Adequate fluid volume intake is essential in pregnancy but is not responsible for the development of physiologic anemia or the corresponding fatigue.

A patient at 24 week' gestation reports to the clinic nurse that she is tired all the time. What is the nurse's best response? a. "Everyone has chronic anemia at this time in pregnancy." b. "I'll make sure your health care provider is informed of your concern." c. "Your urine is clean of protein and sugar. You are doing well at this time." d. "Make sure you are drinking enough fluid to keep up with the demands of your body."

D. Determine if there are any factors that might prohibit her from seeking medical care. The patient has presumptive and probable indications of pregnancy. However, she has not sought out health care until late in the first or early in the second trimester. The nurse must assess for barriers to seeking health care, physical or emotional, because regular prenatal care is key to a positive pregnancy outcome. Asking if the patient has nausea or vomiting will only add to the list of presumptive signs of pregnancy, and this information will not add to the assessment data to determine whether the client is pregnant. The patient needs to see a health care provider before the next 4 weeks because she is late in seeking early prenatal care. Ultrasounds must be prescribed by a health care provider and ordering one is not in the nurse's scope of practice

A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the best nursing action related to this information? a. Ask the patient if she has had any nausea or vomiting in the morning. b. Schedule the patient to be seen by a health care provider within the next 4 weeks. c. Send the patient to the maternity screening area of the clinic for a routine ultrasound. d. Determine if there are any factors that might prohibit her from seeking medical care.

B. Has toxic effects on the fetus The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been shown to cause fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH.

A pregnant client asks the nurse if she can double her prenatal vitamin dose because she doesn't like to eat vegetables. What is the nurse's response about the danger of taking excessive vitamins? a. Increases caloric intake b. Has toxic effects on the fetus c. Increases absorption of all vitamins d. Promotes development of pregnancy-induced hypertension (PIH)

Blurred vision Headache not relieved with over the counter medication Epigastric pain

A pregnant client at 32 weeks gestation has mild pre-eclampsia. She is discharged home with instructions to remain on bedrest. She should also be instructed to call her provider if she experiences which of the following symptoms? (select all that apply)

C. explain to the client that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms. The presentation of heartburn is a normal abnormal finding that can occur in pregnant woman because of relaxation of the lower esophageal sphincter as a result of the physiologic effects of pregnancy. Although foods may contribute to the heartburn, the client is asking why this presentation is occurring, so the nurse should address the cause first. It is independent of gestation. There is no need to refer to the physician at this time because this is a normal abnormal finding. There is no evidence of complications ensuing from this presentation.

A pregnant client complains of frequent heartburn. The client states that she has never had these symptoms before and wonders why this is occurring now. The best response that the nurse can provide is: a. examine her dietary intake pattern and tell her to avoid certain foods. b. tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term. c. explain to the client that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms. d. refer her to her health care provider for additional testing because this is an abnormal finding.

B. Effects of estrogen on the respiratory tract Increasing estrogen levels during pregnancy can affect the respiratory tract passages, leading to increased vascular responses that manifest as cold like symptoms. Progesterone, as the hormone of pregnancy, maintains the pregnancy and does not have any direct effects on the maternal respiratory passages. Although it is possible for a client to develop allergies based on exposure to antigen triggers, it is not typically associated with pregnancy states. An increase in fluid may lead to potential edema, but it is not associated with cold like symptoms.

A pregnant client complains that since she has been pregnant, her nose is always stuffed and she feels like she has a cold. Past medical history is negative for respiratory problems such as hay fever, sinusitis, or other allergies. What is the most likely cause for the client's presentation? a. Increased effects of progesterone to maintain the pregnancy b. Effects of estrogen on the respiratory tract c. Development of allergies as a result of pregnancy because of altered immunity d. Increase in fluid consumption during pregnancy leading to overhydration

Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis (Nose Bleed). Which is the correct interpretation of these symptoms by the health care provider?

"Your baby's umbilical cord is surrounded by connective tissue called Wharton's Jelly, which prevents compression of the blood vessels and ensures continued nourishment and oxygen to your baby."

A woman asks the nurse: "What protects my baby's umbilical cord from being pinched while the baby's inside". The nurse's best response is

Placenta abruption

A woman is 39 weeks gestation with severe abdominal pain that remains constant is being admitted to the labor and delivery unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, has dark red vaginal bleeding and a tense rigid abdomen. What should the nurse suspect at this time?

Slightly above the symphysis pubis

A woman is at 14 weeks gestation. The nurse would expect to palpate the fundus at which level

changes in the pattern of fetal activity

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be which of the following?

4-1-2-0- 4

A woman's obstetrical history indicates that she is pregnant for the 4 th time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

Terbutaline (brethine)

At 32 weeks of pregnancy, a woman experiences preterm labor. Although tocolytics are administered and she is placed on bed rest, she continues to experiences regular contractions and her cervix is beginning to dilate and efface. What additional medication should be considered to assist the development of the fetus?

Walking

Activity is an important component of prenatal teaching. Activity that is considered safe for a client that states she does not participate in any activity or exercise program at this time would be

More than 1 pad an hour

After a miscarriage when should the women call for abnormal bleeding?

Fetal heart tones, Fetal movement, and Fundal height

As a nurse working in a prenatal clinic it is important to obtain both maternal and fetal assessments. While obtaining fetal assessments, which of the following should the nurse complete for fetal well being?