chapter 15, 16: pregnancy, labor and delivery
breast changes
- change in breast sensation that may range from mildly heightened sensitivity to pain - Montgomery tubercles (also called Montgomery glands') sebaceous glands that cover the areolae and moisturize the nipples, also hypertrophy. colostrum produced midway through pregnancy
A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus?
- chorion and amnion explanation: The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.
Active phase of labor:
3-7 cm moderate to strong contractions regular q 3-5 min lasts 30 to 45 sec
amnion
Innermost membranous sac surrounding the developing fetus - space between the amnion and the ebryo is the amniotic cavity > fluid inside= amniotic fluid
chorion
Outermost layer of the two membranes surrounding the embryo; it forms the fetal part of the placenta.
hair and nails changes
estrogen stimulates hair follicles- more hair less hair loss diverse nail changes = may become softer brittle or hard.
fetal pole
the earliest form of the embryo that may be visualized by ultrasound. - may be seen at 3-4 weeks after fertilization
A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. What statement would the nurse include when describing this test to the woman?
"A small piece of tissue from the fetal placenta will be removed and analyzed." Explanation: percutaneous umbilical sampling involves the insertion of a needle into the umbilical vessel. - an amniocentesis involves the collection of amniotic fluid from the amniotic sac. - fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus. - chorionic villus sampling involves the removal of a mall tissue specimen from the fetal portion of the placenta.
A nursing instructor is teaching students about the labor and delivery process and recognizes a need for further teaching when overhearing a student make which statement?
"Anxiety can speed up the labor process." Explanation: Anxiety causes the release of catecholamines, which slow down the labor process. Current research demonstrates that continuous labor support by a caring nurse results in better birth outcomes.
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?
"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." Explanation: 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.
The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse?
"I am glad I can have my two cups of coffee in the morning again." Explanation: Breastfeeding mothers should avoid caffeine because it delays iron absorption and passes through the milk and can slow infant weight gain. Similarly, spicy foods pass into the breastmilk and can affect the baby. Breastfeeding mothers need added calories and fluids.
A client with a prepregnant BMI of 26 is concerned about gaining weight during pregnancy. Which statement by the client indicates an appropriate goal for this pregnancy?
"I need to consume at least 1,500 nutrient-dense calories each day." Explanation: An overweight client needs at least 1,500 calories per day. Choosing nutrient-dense calories helps to limit excessive weight gain. Carbohydrates are needed for energy. Small, frequent meals help to maintain a constant blood glucose level and decrease binge eating
A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?
"I should substitute intercourse with nonsexual touch to avoid harming the fetus." Explanation: - Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. - Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding
The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed?
"Pain with urination is expected during pregnancy." Explanation: Pain on urination is a symptom of a urinary infection, potentially serious because these are associated with preterm birth.
A woman has recently found out that she is pregnant. She comes to the nurse with complaints about breast tenderness and fatigue. What is the best response from the nurse?
"That must be hard for you. Let's think of some ways to decrease this discomfort you are feeling." Explanation: Breast tenderness and fatigue are normal discomforts in the first trimester. Empathic and sound advice about measures to relieve these discomforts helps promote overall health and well-being.
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?
"The analgesia will reduce the sensation of pain for a limited period of time." Explanation: It is best to prepare the client for the role of analgesia in her labor experience. It is best to explain that analgesia will reduce, not block or eliminate, the pain sensation for a limited period of time depending upon the medication selected
A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding her progress?
"You are still 2 cm dilated, but the cervix is thinning out nicely." Explanation: Women are anxious to have frequent reports during labor, to reassure them everything is progressing well. If giving a progress report, the nurse should remember most women are aware of the word dilatation but not effacement.
When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?
"You have no trouble walking around and using the bathroom after you receive the epidural." Explanation: Epidural anesthesia impairs mobility; most clients are placed on bed rest after epidural anesthesia is given. Urinary catheterization is frequently required.
latent phase
- contractions are mild - contractions last about 30 -40 seconds and may be as close together as 3 minutes or far as 30mins menstrual cramps pain and low backache
respiratory system pg 262
- diaphragm elevated - women may experience dyspnea throughout pregnancy. may result in respiratory alkalosis. - blowing off more CO2 allows for CO from the fetal circulation to diffuse into mothers blood stream and O1 to diffuse from mother to fetus thus improving oxygenation to fetus.
cardinal movements of labor pg 297
- engagement - the head reaches the level of the ischial spines, typically at station 0, which may occurs prior to labor or in early labor - descent - flexion - - internal rotation - extension - external rotation - expulsion
second stage
- fully dilated to birth of the infant - The Ferguson reflex typically starts when the presenting part is at station +1 -
cervix changes
- goodell's sign. caused by same changes of hegar's sigg > soft cervix - operculum: mucous plug inside cervical canal created by irregular network of mucous-producing cells (glandullar cells of the cervix hypertrophied) - as cervix opens "bloody show" happens
uterus changes
- hypertrophy and hyperplasia - Between 16 and 36 weeks of gestation, the size of the uterus in centimeters, when measured from the pubic symphysis to the fundus, should equal the number of weeks of gestation. - braxton hicks may be clinically detected as early as 6 weeks. - The blood flow to the uterus increases 20-fold during pregnancy, with most of this blood traveling through the intervillous space of the placenta so the exchange of nutrients and oxygen from the mother and waste from the fetus can occur - In very early pregnancy, this increased vascularity of the uterus causes Hegar's sign, a softening of the lower portion of the uterus that can cause the entire uterus to flex forward in early pregnancy. may contribute to urinary frequency.
Cardiac output
- increased as much as 50% - 15 -20 beat increase - 25-30% increase in SV - total blood volume ^ by 40-50% - RBC count ^ 30% - H& H is decreased - the relative increase in plasma volume over the RBC count would suggest anemia. This is normal.
WBC count
- increased. - 9-15 normal - fibrinogen levels, as well as those of other clotting factors, may rise considerably, particularly in late pregnancy and the postpartum period.
pancreas during pregnancy
- insulin needs slightly drop in late first trimester and early second trimester, then increase until end of pregnancy - reduction in the responseiveness of the cells of mothers body to insulin which can be overcome by ^ greater production of insulin - The women whos pancreas cannot keep up with cellular demand for ^ insulin = gestational diabetes
urinary system
- kidneys become larger for more retention - ureters stretch and grow - blood flow increases because of the combination of increased blood volume, particularly plasma volume and increased CO. > causes 50% increase in gfr (blood plasma filtered) - Because of changes in the tubular function, which shunts nutrients back into the bloodstream while disposing of waste into the renal pelves and ureters, it is not uncommon for women to spill glucose and protein into the urine. it is considered physiologic in small amounts (common like anemia) - It should be noted, however, that new glucose in the urine may signal gestational diabetes, and new protein in the urine may cue evaluation for preeclampsia, especially after the 20th week gestation
first stage of labor
- lasts an average of 12 hours - ends with the cervix dilated at 10 cm - divided into latent, active and transition
thyroid gland pg 261
- mother supplies fetus until 12th week. - tri-iodothyronine and thyroxine are critical to fetal neurologic development. - maternal hypothyroidism has been associated with miscarriage, preeclampsia, gestational diabetes, preterm birth, placental abruption, cesarean section, and induction of labor - hyperthyroidism - linked to preeclampsia and Csection. - blood levels of thyroid horm are often increased
linea nigra
- pigmentation change. occurs more commonly in darker skin - starts at pubic symphysis and varies in length - linea nigra generally disappears after pregnancy as estrogen, progesterone, and melanocyte-stimulating hormone decrease to their normal, prepregnancy levels
Blood pressure
- typically decreases, particularaly early - from hormones acting on vessels to decreases pvr
Transition phase of labor
- typically lasts less than 2 hrs - contraction starting every 1 - 2 minutes and lasting 40-60 seconds each - An increase in bloody vaginal discharge is also typical of this phase. Delivery preparation begins at this time
Human chorionic somatomammotropin (hCS)
-exclusively produced by the placenta is hCS -hCS appears later in pregnancy and continues to rise. hCS acts directly on the mother's metabolism, increasing the insulin resistance of her cells, and thereby increasing her circulating glucose. - cues breasts to prepare for lactation. - surplus glucose across placenta to the pregnancy facilitated by hCS
pituitary gland pg 262
-prolactin = produced primarily by anterior pituitary. active in milk production - oxytocin = produced by posterior pituitary. stimulates milk ejection. also on the uterus to produce contractions prior to labor and during childbirth. Also prevents excess bleeding after delivery
A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?
1 lb (.45 kg) Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters - underweight = slightly more than 1 lb - overweight = 2/3 lb per week
The nurse notices that a client in labor who is receiving an epidural has suddenly become drowsy. When the nurse asks her how she is doing, the client complains of a metallic taste in her mouth and blurred vision. Her speech is slurred. The nurse recognizes this as a serious complication related to the epidural. Which intervention would the nurse implement as a priority in this situation? Select all that apply.
1) Administer oxygen to the client 2) Administer an anticonvulsant to the client 3) Prepare for prompt birth of the fetus Explanation: In rare instances, the anesthetic, instead of settling into the epidural space, enters the woman's blood circulation. Drowsiness, a metallic taste on the tongue, slurred speech, blurred vision, unconsciousness, and seizure which may lead to cardiac arrest are alerts this has happened and, again, is an emergency situation - IV Ringer's lactate should have occurred before the epidural - Be sure to caution women not to take acetylsalicylic acid (aspirin) for pain in labor as aspirin interferes with blood coagulation, increasing the risk for bleeding in the newborn or herself.
A pregnant client is scheduled to undergo chorionic villi sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?
10 to 12 weeks of gestation Explanation: Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation.
You are discussing weight gain with a group of pregnant women at the clinic. One woman is very thin and her prepregnancy weight falls below the normal weight range for her height. What is her recommended weight gain during her pregnancy?
28 to 40 pounds Explanation: Current weight gain recommendations for pregnancy are based on prepregnancy body mass index (BMI). Recommended: - normal = 25 to 35 pounds -underweight = 28-40 pounds - overweight = 15 to 25 pounds - obese at time of conception = at least 15 lbs
The nurse has been monitoring a multipara client for several hours. She cries out that her contractions are getting harder and that she cannot do this. The nurse notes the client is very irritable, nauseated, annoyed, and doesn't want to be left alone. Based on the assessment the nurse predicts the cervix to be dilated how many centimeters?
8 to 10 Explanation: The reaction of the client is indicative of entering or being in the transition phase of labor, stage 1. The dilation would be 8 cm to 10 cm. Before that, when dilation is 0 to 7 cm, the client has an easier time using positive coping skills.
Which of the following changes, with highest priority, should the nurse teach a pregnant patient to report to the health care provider as soon as possible?
Abdominal pain coming and going during the third trimester Explanation: -Any abdominal pain needs to be reported to the health care provider ASAP. This could be a sign of preterm labor and needs to be addressed. - vomiting during first trimester is normal -heartburn is caused by shifting organs. - frequent urination is the result of increased pressure on the bladder
An Rh-negative patient is having an amniocentesis. What is the highest priority nursing intervention to perform immediately after the procedure?
Administer Rh immune globulin explanation: a woman with Rh-neg blood type and having an amniocentesis needs Rh immune globulin after the procedure to protect against fetal isoimmunization.
An Rh-negative patient is having an amniocentesis. What is the highest priority nursing intervention to perform immediately after the procedure?
Administer Rh immune globulin. Explanation: A woman with Rh-negative blood type and having an amniocentesis needs Rh immune globin after the procedure to protect against fetal isoimmunization
The nurse discovers a new prescription for RhoGAM for a client who is about to undergo a diagnostic procedure. The nurse will administer the RhoGAM after which procedure?
Amniocentesis - Explanation: Amniocentesis is an invasive procedure whereby a needle is inserted into 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.
Which statement is true regarding analgesia versus anesthesia?
Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. Explanation: Systemic analgesia should be used with caution near the time of birth because it can cause respiratory depression, in addition to decreased FHR variability. Hypotension is a common side effect of regional anesthesia.
The nurse is preparing to assess the nutritional status of a patient who is 8 weeks pregnant. What is the most effective way for the nurse to assess the patient's food intake thus far in the pregnancy?
Ask the patient to describe intake for the last 24 hours. Explanation: The best method for assessing a woman's nutritional intake during pregnancy is to ask the patient to list all the food eaten within the past 24 hours, starting with waking up until going to sleep. This method of history taking yields much more accurate information than asking a patient how often a specific food is eaten. - Assessing skin status may provide more information about hydration that nutritional status
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?
Assess amount of cervical dilation. Explanation: If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation.
Which precaution would you take with a pregnant woman following an amniocentesis?
Assess fetal heart rate and possible uterine contractions. Explanation: Because amniocentesis is an invasive procedure, there is a risk that it might initiate uterine contractions. Assessing for contractions postprocedure is important to safeguard the pregnancy.
The nurse has just applied a sterile pressure dressing to an epidural site after removing the epidural catheter in a client who is now recovering from a standard delivery. Which action should the nurse now prioritize?
Assess return of sensory and motor functions to the lower extremities. Explanation: After removal of the epidural catheter and medication is terminated, the nurse needs to assess for return of motor function to ambulate the mother. The mother will not be able to walk for some time (at least until the medication wears off). Do not elevate the legs; the goal is to maintain normal circulation.
A pregnant woman has a child at home who has been diagnosed with neurofibromatosis. She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby?
Café-au-lait-spots explanation -family history of neurofibromatosis type 1, an inherited condition involving tumors of the central nervous system, would prompt the nurse to carry out a detailed assessment of closely related family members.
A client received epidural anesthesia and developed a postdural spinal headache. Which of the following should the nurse know about a postdural spinal headache?
Client should be encouraged to drink plenty of fluids Explanation: A client with a postdural spinal headache should be encouraged to drink plenty of fluids. Treatment of postdural spinal headache usually includes proper hydration.
A pregnant woman tells you that she wants to avoid saturated fat by using vegetable oil. What is another advantage of vegetable oil?
Contains linoleic acid Explanation: Linoleic acid is a fat important for skin integrity in the mother and for fetal growth.
Between her regularly scheduled visits, a woman in her first trimester of pregnancy who is taking iron supplements for anemia calls the nurse at her obstetrician's office reporting constipation. She reports that she has never had this problem before and asks for some advice about how to get relief. What is the best advice the nurse can give her?
Continue taking iron supplements but increase fluids and high-fiber foods; exercise more. Explanation: - constipation is common w/ iron supp -The diagnosis of anemia indicates a true need for the iron supplementation - The nurse should not advise this client to stop taking her iron supplements, even for a few days. - The nurse should not advise the client to increase her iron supplementation, nor take the supplements on an every other day basis
A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method?
Counterirritation stimulation blocks pain from traveling to the spinal cord. Explanation: Transcutaneous electrical nerve stimulation (TENS) works to relieve pain by applying counterirritation to nociceptors. Low-intensity electrical stimulation blocks the afferent fibers, preventing pain from traveling to the spinal cord synapses from the uterus
The nurse is caring for a client experiencing pruritus secondary to opioid medication administration during labor. When reviewing the medication administration record, which medication would the nurse offer the client?
Diphenhydramine Explanation: Diphenhydramine is an antihistamine which would be helpful to the client experiencing pruritus as a side effect of opioid medication administration
A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's level is decreased?
Down syndrome Explanation: - Decreased levels might indicate Down syndrome or trisomy 18. - sickle cell anemia may be identified by chorionic villus sampling
fetus
From week 9 until the end of pregnancy - the luteal phase between ovulation and menses is 14 days if fertilization does not occur - With a 28-day cycle, the follicular phase between the first day of menses and ovulation is also 14 days. By this calculation, ovulation and fertilization occur 14 days after the first day of the LMP, so the embryonic or fetal age is 2 weeks less than gestational age.
The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes?
Goodell sign explanation: the description of goodell sign is softening of the cervix
The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal?
Increased WBC count Explanation: The nurse should identify increased white blood cell count as the hematological change occurring in a client during labor. The increase in the white blood cell count can be attributed to physical and emotional stress during labor - during labor there is a decreased in blood coagulation time and an increased plasma fibrinogen level. - glucose levels are decreased during labor
what type of sign is visualization of the pregnancy by ultrasound?
Positive sign - pregnancy and location in uterus can be seen by 5 weeks and fetal hr can be seen by 6 weeks - fetal movement palpable by 20 weeks - all positive signs are considered confirmatory of a pregnancy
The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?
Quickening Explanation In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas -Lightening is the descent of the presenting part of the fetus into the pelvis - Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os - Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon. Explanation: This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy > a warm bath is important rather than hot bath - Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple.
The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?
Rubella Explanation: Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.
The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from?
Rubella Explanation: the baby does not receive immunity to rubella, cytomegalovirus, varicella, or measles. If women encounter these pathogens during her pregnancy, fetal infection may ensue.
A laboring client is restless and moving frequently in the bed. She appears to be more uncomfortable with the contractions but refuses pain medication when offered. The client's partner has left the room to stretch his legs. Which response by the nurse is most helpful?
Stand next to the client at the side of the bed. Explanation: The client is alone and progressing well in labor as evidenced by her restlessness. She is refusing analgesia but will benefit from awareness that the nurse is attending her at the bedside and that she is not alone
striae gravidarum
Stretch marks, which can develop over the abdomen, breast, and thighs
When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful?
The characteristics of labor pain follow a pattern. While pain is individualized, labor pain is defined and follows a pattern. Since it follows a typical path, education and planning is completed
The nurse is caring for a client who has an irregular pattern of uterine contraction. As a result, the nurse anticipates a problem with which?
The powers Explanation: One of the four "P's" is the power of the uterine contractions. This power begins with regular contractions which become closer together and increase in intensity.
What should the nurse explain to the pregnant client about the importance of the fetal stage of development?
There is additional growth and development of the organs and body systems. Explanation: The fetal stage is from the beginning of the ninth week after fertilization and continues until birth. At this time, the developing human is called a fetus.
A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor?
These contractions help in softening and ripening the cervix. Explanation -assist in labor by ripening and softening the cervix and moving the cervix from a posterior position to an anterior position -Prostaglandin levels increase late in pregnancy secondary to elevated estrogen levels - Braxton Hicks contractions do not help in bringing about oxytocin sensitivity. - Occurrence of lightening, not Braxton Hicks contractions, makes maternal breathing easier.
adrenal glands
^ in cortisol and aldosterone. cortisol ^ second trimester and peak 3rd trimester (late surge may help promote lung and neurologic development of fetus) - aldosterone helps retain sodium that would otherwise be excreted. this helps swell blood volume over course of pregnancy
The fetal-assessment technique of a rhythm strip refers to:
a tracing of fetal heart rate and pattern. Explanation: Rhythm-strip testing is recording the fetal heart rate and pattern by an external monitor.
A woman whose fetus in in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain?
applying counter pressure to the back Explanation: Counter pressure applied to the lower back with a fisted hand sometimes helps the woman cope with "back labor" associated with occiput-posterior positioning
vascular changes during pregnancy
blood vessels dilate and proliferate because of increases in estrogen levels. superficial blood vessels become more prominent in early pregnancy
What anatomic area should be examined when assessing Montgomery tubercles?
breasts Explanation: Montgomery tubercles are sebaceous glands on the areola of the breasts and are prominent during pregnancy.
A pregnant client in her first trimester visits the health care facility for regular checkups. The nurse instructs the client to increase her dietary intake of folic acid based on the understanding that folic acid is important for which action?
decreasing incidence of birth defects explanation: folic acid is important because it decreases the risk of birth defects, including neural tube defects. Folic acid has no effect on increasing the mother's energy level or resistance to disease or decreasing her risk of breast cancer.
A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped?
end of week 16 Explanation: At the end of 16 weeks, the lungs are fully shaped, fetus swallows amniotic fluid, skeletal structure is identifiable, downy lanugo hair is present on the body, and sex can be determined using ultrasound.
A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with shoulder presentation during a vaginal birth should the nurse assess?
fetal anomalies Explanation: The nurse, along with the primary care provider, has to assess for fetal anomalies, which are usually associated with a shoulder presentation during a vaginal birth. The other conditions include placenta previa and multiple gestations. Uterine abnormalities, congenital anomalies, and prematurity are conditions associated with a breech presentation of the fetus during a vaginal birth.
Which of the following is a positive sign of pregnancy?
fetal movement felt by examiner explanation: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and examiner feeling fetal movement.
A nurse palpates a woman's fundus to determine contraction intensity. What would be most appropriate for the nurse to use for palpation?
finger pads Explanation: To palpate the fundus for contraction intensity, the nurse would place the pads of the fingers on the fundus and describe how it feels - DO NOT: use finger tips, palm or back of the hand
placenta pg 257
formation: grows from site of blastocyst implantation on the uterus. composed of tissue from both. chorionic villi burrow into the decidua basalis of uterus. the fetal side of the placenta is formed by the chorionic villa and lined by the amnion. maternal side is formed by the decidua basalis. structure: Outer surface - shiny schiltze side that joins the decidua has red meaty appearance - dirty duncan functional part of placenta that sits between maternal and fetal blood supply - syncytiotrphoblast function 3 primary functions: 1) circulation 2) protection 3) hormone production
A nurse is listening to a patient's heart and determines that there is a change since the last normal prenatal visit. The patient has no history of heart disease, so which of the following should the nurse expect has developed?
functional murmur Explanation: Because of the increased blood flow past valves, functional (innocent) or transient murmurs can be heard in many women during a usual pregnancy - Women who had Kawasaki disease or rheumatic fever as a child may have both valvular and aortic artery constrictions that lead to true valve dysfunction and organic murmurs.
A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?
hemorrhoids Explanation: The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman
A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply.
increase in heart rate increase in blood pressure increase in respiratory rate Explanation: When caring for a client in labor, the nurse should monitor for: - increase in the heart rate by 10 to 20 bpm -increase in blood pressure by as much as 35 mm Hg - increase in respiratory rate. During labor, the nurse should monitor for a slight elevation in body temperature as a result of an increase in muscle activity. - The nurse should also monitor for decreased gastric emptying and gastric pH, which increases the risk of vomiting with aspiration.
A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?
increased secretion of insulin occurs in the first trimester explanation: -Increased secretion of insulin in the maternal body in the first trimester is due to the rise in serum levels of estrogen, progesterone, and other hormones. During the second half of pregnancy, tissue sensitivity to insulin progressively decreases, producing hyperglycemia and hyperinsulinemia. - use of insulin needs to be increased as pregnancy advances. - Insulin resistance becomes maximal not minimal in the latter half of the pregnancy.
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?
once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Explanation: 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) - 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.
A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure?
placenta Explanation: The placenta is a flat, round structure which forms on the decidua and attaches to the fetus by the umbilical cord. The placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus - The amniotic fluid surrounds the fetus and provides protection, temperature regulation, allows movement, and symmetric growth. It collects urine and other waste products from the fetus - The umbilical arteries carry waste products away from the fetus to the placenta, where they are filtered out into the maternal body for proper disposal.
A patient who is in her 9th month of pregnancy comes to the emergency department and reports that bright red blood is coming from her vagina. She denies having any pain. What needs to be ruled out before a vaginal examination can be performed?
placenta previa Explanation: Vaginal examinations should never be done if the woman presents with bright red painless bleeding until placenta previa is ruled out.
what is the most common probable sign ?
pregnancy test -hCG doubles in early pregnancy approximately every 48 to 72 hours, and is produced starting at the time of implantation
relaxin pg 259
produced by the placenta. - highest levels are during 1st trimester and time of delivery - preparation of the endometrium for implantation during the beginning and then softens the cervix at the end - joint laxity - optimizes circulatory system during pregnancy - too much could cause preterm too little may disrupt maternal glucose metabolism.
palmar erythema
redness of the soles of the feet and palms of the hands. caused by increased blood flow.
what is fetal attitude
refers to the position of the fetal body parts in relation to each other. - typically this includes legs flexed at the knees, arms flexed against the chest, back rounded, and the neck flexed with the chin on the chest = general flexion.
A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. What is this hormone?
relaxin Explanation: relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening allows for dilation at birth. The effect of estrogen is to cause breast and uterine enlargement.
When the primary caregiver is hospitalized, this creates the need for _________ within the family.
role reversal Explanation: The question asks for a positive change that needs to happen in the family. Role reversal is a positive change, even though it will take work on the part of all family members.
Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation?
shoulder The three main fetal presentations are cephalic or vertex, with the head as the presenting part, breech, with the pelvis as the presenting part, and shoulder, with the scapula as the presenting part.
Wharton's jelly pg 259
slippery substance - surrounds the blood vessels - helps the cord slid back and forth between the fetus and the wall of the amniotic sac, preventing compression
A pregnant client is to receive fentanyl IV for pain control during labor. The nurse would assess the client for which possible effect?
slowing of labor Explanation: Fentanyl when given IV can lead to hypotension, respiratory depression, and a slowing of labor.
The nurse is assessing a pregnant woman on a routine prenatal visit. Which breast assessment finding will the nurse document as a normal and expected finding?
tingling sensations and tenderness Explanation: Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery tubercles, prominence of superficial veins, development of striae, and expression of colostrum in the second and third trimesters.
Which condition is the most commonly occurring chromosomal disorder?
trisomy 21 Explination: Fragile X syndrome is the most common cause of intellectual disability in males. Children with Klinefelter syndrome are males with an extra X chromosome; the child with Turner syndrome (gonadal dysgenesis) has only one functional X chromosome. Neither disorder is considered the most common chromosomal disorder.
A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy?
visualization of the fetus by ultrasound three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound presumptive symptom ex: absence of a period probable sign ex: tests of urine or blood for hCG
