Chapter 15 ?'s OB

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? 1 end of 4 weeks 2 end of 8 weeks 3 end of 12 weeks 4 end of 16 weeks

4

A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action? 1 Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. 2 Reassure the mother that this is normal as the baby is implanting into the uterus. 3 Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten. 4 Encourage her to ambulate since gas pains are common in early pregnancy.

1

A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Feedback A Gastric motility decreases during pregnancy. B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. C Glucose levels decrease in the first trimester. D Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

A client in her second trimester of pregnancy complains to the nurse of heartburn. Which of the following should the nurse suggest to the client as a preventative measure? 1 Have small frequent meals 2 Use extra pillows when sleeping 3 Eat dry crackers and toast before rising 4 Drink plenty of fluids before bedtime

1

When obtaining a prenatal history on a pregnant patient the nurse notes a family history of sickle cell disease. Given this information, what lab test can the nurse anticipate the physician will order? a. Endovaginal ultrasound b. Pap test c. Complete blood count d. Hemoglobin electrophoresis

d. Hemoglobin electrophoresis Hemoglobin electrophoresis identifies presence of sickle cell trait or disease (in women of African or Mediterranean descent). It is ordered in the first trimester, if indicated. Page 46, Table 4-1

The nurse encourages adequate intake of folic acid for women of childbearing age before and during pregnancy. What is folic acid thought to decrease the incidence of in fetal development? a. Structural heart defects b. Craniofacial deformities c. Limb deformities d. Neural tube defects

d. Neural tube defects Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly. Page 45 | Page 61

A nurse is performing a physical assessment of a woman in labor. As part of her assessment, she examines the outer and inner surfaces of her lips. What is the best rationale for this assessment? 1 Detection of herpes virus infection 2 Detection of a respiratory infection 3 Detection of anemia 4 Detection of rales

1

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client? 1 Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. 2 Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus. 3 Long soaks in very hot water are encouraged during pregnancy to promote relaxation. 4 Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus.

1

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? 1 relaxin 2 progesterone 3 estrogen 4 human placental lactogen

1

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? 1 Fats are essential during pregnancy, and vegetable oils are a good source. 2 Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources. 3 Fats are not essential during pregnancy and thus are optional. 4 Fats should be avoided during pregnancy.

1

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately: 1 85 beats per minute. 2 90 beats per minute. 3 95 beats per minute. 4 100 beats per minute.

1

Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? 1 clean catch urine 2 initial blood tests 3 measurement of fundal height 4 ultrasound for fetal measurements

1 The first procedure a nurse should ask the client to do is obtain a clean catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or ultrasound done.

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? 1 Trace of glucose 2 2+ Protein in urine 3 Specific gravity of 1.010 4 Straw-like color

2

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as the: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign.

A. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

ANS: D Feedback A Fetal movement is a presumptive sign of pregnancy. B Amenorrhea is a presumptive sign of pregnancy. C Breast changes are a presumptive sign of pregnancy. D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% Hct; 14 g/dL Hgb B. 35% Hct; 13 g/dL Hgb C. 33% Hct; 11 g/dL Hgb D. 32% Hct; 10.5 g/dL Hgb

C. 33% Hct; 11 g/dL Hgb This is within normal limits in the nonpregnant woman. This is within normal limits for a nonpregnant woman. Represents the lowest acceptable value during the first and the third trimesters. This represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman? a. Exercise elevates the mothers temperature and improves fetal circulation. b. Exercise increases catecholamines, which can prevent preterm labor. c. A regular schedule of moderate exercise during pregnancy is beneficial. d. Pregnant women should limit water intake during exercise.

c. A regular schedule of moderate exercise during pregnancy is beneficial. In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy. Page 62

A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. How would the nurse document the patients obstetric history using the TPALM system? a. Gravida 2, para 20120 b. Gravida 3, para 10011 c. Gravida 3, para 10110 d. Gravida 2, para 11110

c. Gravida 3, para 10110 Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para. Page 48, Box 4-1

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? 1 Reduce walking to half a block daily. 2 Continue this as long as she enjoys it. 3 Stop and rest every block. 4 Engage in aerobics for greater benefits.

2

The nurse is emphasizing the importance of adequate rest and sleep with a pregnant patient. Which position should the nurse suggest the patient use? 1 On the back with a pillow under the head 2 On the stomach with a pillow under her breasts 3 On the back with a pillow under the knees and hips 4 On the side with the weight of the uterus on the bed

4

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? 1 Split S1S2 2 Premature ventricular contractions 3 S4 (atrial gallop) 4 Soft systolic murmur

4

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? 1 limiting carbohydrate intake 2 limiting intake of heavy, greasy foods 3 increasing fluid intake 4 drinking liquids with meals

2

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? 1 Keep the client's legs slightly elevated. 2 Place the client in an orthopneic position. 3 Keep the head of the client's bed slightly elevated. 4 Place the client in the left lateral position.

4

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? 1 Perform nipple exercises and stimulation on a regular basis. 2 Take a hot water bath or shower daily to maintain hygiene. 3 Apply lanolin ointment to the nipple and areola to prevent cracking. 4 Rest on the left side for at least 1 hour in the morning and afternoon.

4

During her first prenatal visit, a woman 18 weeks pregnant reports she did not realize she was pregnant and continued to take her birth control pills. She is concerned about their effects on her baby. Which of the following would be the best response to her concerns? 1 "There are no risks to the fetus related to the ingestion of birth control pills during pregnancy." 2 "Because of concerns about the estrogen exposure to the baby, we will monitor the fetal development." 3 "As long as you did not take them too far into the second trimester, there is no risk." 4 "Birth defects are a realistic possibility and must be monitored."

2

The nurse is assisting a primigravid on calculating the due date of her baby using Naegele's rule. The most important information provided by the mother is: 1 the first day of the last menstrual period. 2 the ovulation date between her periods. 3 the date that intercourse occurred. 4 the last day of her menstrual period.

1

The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed? 1 "Pain with urination is expected during pregnancy." 2 "I should call the doctor if I have any vaginal bleeding." 3 "A sudden rush of fluid means that my membranes ruptured. 4 "I should not worry if I vomit once a day for the first 12 weeks."

1

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. 1 increase in heart rate 2 increase in blood pressure 3 increase in respiratory rate 4 slight decrease in body temperature 5 increase in gastric emptying and pH

1 2 3

As part of her physical examination of a pregnant client, the nurse examines the woman's breasts. Which are healthy breast changes that indicate pregnancy? Select all that apply. 1 areolae darken 2 overall breast size increases 3 blue streaking of veins becomes prominent 4 montgomery tubercles become prominent 5 breasts become softer in consistency 6 hard, painless lumps form

1 2 3 4

A patient who is 2 months pregnant is concerned about frequent urination. What should the nurse instruct the patient about this occurrence? 1 This means urine is more concentrated. 2 It is caused by pressure on the bladder from the uterus. 3 The fetus is adding urine to the patient's bladder. 4 There is a decrease in the glomerular cells of the kidney.

2

During a routine antepartal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse do next? 1 Notify the healthcare provider of a possible infection. 2 Tell the woman that this is entirely normal. 3 Advise the woman about the need to culture the discharge. 4 Check the discharge for evidence of ruptured membranes.

2

The nurse is assigned to clients who are having the following procedures: <Amniocentesis, Fetal nonstress test, Chorionic villus sampling, Percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate. For which clients will the nurse ensure that the informed consent is on the chart? 1 Amniocentesis, chorionic villus sampling, fetal nonstress test 2 Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling 3 Fetal nonstress test, Doppler assessment of fetal heart rate 4 Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate

2

The nurse is completing a physical assessment with a patient who has just learned of being pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the patient that the baby will be due? 1 July 15 2 May 22 3 June 22 4 April 15

2

The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? 1 Nosebleeds 2 Heartburn 3 Blood clots 4 Constipation

2

A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy? 1. Cardocentesis. 2. Amniocentesis. 3. Nuchal translucency testing. 4. Chorionic villi sampling.

2.

A patient who is 16 weeks pregnant has a lower blood pressure than that of prepregnancy levels. What should the nurse realize as being the cause for this lower blood pressure? 1 Prepregnancy blood pressure measurements were inaccurate. 2 Blood pressure progressively decreases throughout the entire pregnancy. 3 A decrease in the second trimester may occur because of placental growth. 4 Dehydration because blood pressure increases steadily throughout pregnancy.

3

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? 1) once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth 2) once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth 3) once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth 4) once every 4 weeks for the first 36 weeks, then weekly until the birth

3

When visiting with a pregnant female for the first time, the nurse should address the topic of rest. Which position should the nurse encourage the woman to assume when resting? 1 supine with a pillow under the knees to ease back strain 2 semi-Fowler's position with head elevated on two pillows 3 left-sided Sims position with the top leg forward 4 right-sided reverse Trendelenburg with pillows under the arms

3

Which reason explains why women should be encouraged to perform Kegel exercises after delivery? 1 They assist with lochia removal 2 They promote the return of normal bowel function 3 They promote blood flow, enabling healing and muscle strengthening 4 They assist the woman in burning calories for rapid postpartum weight loss

3

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? 1 The heart rate increase may indicate that the client is experiencing cardiac overload. 2 The blood pressure should be higher since the cardiac volume is increased. 3 Both findings are normal at this point of the pregnancy. 4 Combined, both of these findings are very concerning and warrant further investigation.

3 A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

An 18-year-old pregnant woman asks why she has to have a routine alpha-fetoprotein serum level drawn. You explain that this 1 is a screening test for placental function. 2 tests the ability of her heart to accommodate the pregnancy. 3 may reveal chromosomal abnormalities. 4 measures the fetal liver function.

3 An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.

A woman at 15 weeks' gestation asks the nurse what the fetus looks like. Which response by the nurse would be most accurate? 1 The fetus is covered with a white, greasy film called vernix. 2 The fetus is about 15 inches in length. 3 Fingernails and toenails are present. 4 Rhythmic breathing movements are occurring.

3 Vernix caseosa, a white, greasy film, covers the fetus at weeks 17 through 20. The fetus reaches a length of approximately 15 inches by weeks 25 to 28. Fingernails and toenails are present by approximately week 13 through 15. Rhythmic breathing movements occur between weeks 29 through 32.

A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse respond about fetal respiration? 1 "You are breathing for the baby." 2 "The baby's lungs can accommodate all of the fluid." 3 "Oxygen is provided to the baby through the placenta." 4 "The baby's breathing is very minor until delivery."

3. Fetal circulation differs from extrauterine circulation because the fetus derives oxygen and excretes carbon dioxide not from gas exchange in the lung but from exchange in the placenta

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? 1 All activities that the client does in a prepregnant state 2 Relaxing activities such as those including hot baths and jacuzzis 3 High impact movements enabling less time in the activity 4 Stretching and breathing exercises such as yoga

4

Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women? a. All women, regardless of risk factors b. A woman who has had more than one sexual partner c. A woman who has had a sexually transmitted infection d. A woman who is monogamous with her partner

ANS: A Feedback A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. B All women should be tested for HIV, although this patient is at increased risk of contracting the disease. C Regardless of past sexual history, all women should have an HIV test completed prenatally. D Although this patient is apparently monogamous, an HIV test is still recommended.

A gravida patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. Observation of posture and body mechanics b. Palpation of the lumbar spine c. Exercise pattern and duration d. Ability to sleep for at least 6 hours uninterrupted

ANS: A Feedback A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. B Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. C Certain exercises can help relieve back pain. D Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.

The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A Feedback A The maternal serum level of alpha-fetoprotein is used to screen for Trisomy 18 or 21, neural tube defects, and other chromosomal anomalies. B The quadruple marker test does not detect this fetal anomaly. Additional testing, such as ultrasonography would be required to diagnose diaphragmatic hernia. C Congenital cardiac abnormality would most likely be identified during an ultrasound examination. D The quadruple marker test would not detect anencephaly.

A woman's last menstrual period was June 10. Her estimated date of delivery (EDD) is a. April 7 b. March 17 c. March 27 d. April 17

ANS: B Feedback A April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. B 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). C March is the correct month, but instead of adding 7 days, 17 days were added. D April 17 is subtracting 2 months instead of 3 months.

A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy? a. Cardiac output rises by 25% b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

ANS: B Feedback A Cardiac output increases by 50% with half of this rise occurring in the first 8 weeks gestation. B The pulse increases about 15 to 20 beats/min, which persists to term. C In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. D Production of RBCs accelerates during pregnancy.

Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B Feedback A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. C Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. D Venous congestion in the breasts is more obvious in primigravidas.

The maternity nurse understands that vascular volume increases 30% to 50% during pregnancy to a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.

ANS: B Feedback A Renal plasma flow increases during pregnancy. B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. C Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. D This is not the primary reason for the increase in volume

Which complaint by a patient at 35 weeks of gestation requires additional assessment? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

ANS: B Feedback A Shortness of breath is an expected finding by 35 weeks. B Abdominal pain may indicate preterm labor or placental abruption. C Ankle edema in the afternoon is a normal finding at this stage of pregnancy. D Backaches while standing is a normal finding during the later stages of pregnancy.

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine

ANS: B Feedback A The presence of protein could indicate kidney disease or preeclampsia. B Small amounts of glucose may indicate "physiologic spilling." C Urinary tract infections are associated with bacteria in the urine. D An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

A woman 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. Her gravida and para are a. Gravida 3 para 2 b. Gravida 4 para 3 c. Gravida 4 para 2 d. Gravida 3 para 3

ANS: C Feedback A Because she is currently pregnant, she is classified as a gravida 4; the pregnancy that was terminated at 8 weeks is classified as an abortion. B Gravida 4 is correct, but she is a para 2. The pregnancy that was terminated at 8 weeks is classified as an abortion. C 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. D Since she is currently pregnant, she is classified as a gravida 4, not a 3. The para is correct.

Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and breasts. These are referred to as a. Chloasma b. Linea nigra c. Striae gravidarum d. Angiomas

ANS: C Feedback A Chloasma is a facial melasma also known as the "mask of pregnancy." This condition is manifested by a blotchy, hyperpigmentation of the skin over the cheeks, nose and forehead especially in dark complexioned women. B Linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline. C Striae gravidarum or stretch marks appear in 50% to 90% of pregnant women during the second half of pregnancy. They most often occur on the breasts and abdomen. This integumentary alteration is the result of separation within the underlying connective (collagen) tissue. D Angiomas and other changes also may appear.

A woman in her first trimester of pregnancy can expect to visit her physician every 4 weeks so that a. She develops trust in the health care team. b. Her questions about labor can be answered. c. The condition of the expectant mother and fetus can be monitored. d. Problems can be eliminated.

ANS: C Feedback A Developing a trusting relationship should be established during these visits, but that is not the primary reason. B Most women do not have questions concerning labor until the last trimester of the pregnancy. C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. D All problems cannot be eliminated because of prenatal visits, but they can be identified.

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Feedback A Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. B The arm should be supported at the same level of the heart. C The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner? a. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist. b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D Feedback A The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. B Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. C Progesterone affects relaxation of the smooth muscles in the respiratory tract. D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy.

The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. Seeking safe passage for herself and her baby b. Securing acceptance of the baby by others c. Learning to give of herself d. Developing attachment with the baby

ANS: D Feedback A This is a task that ends with delivery. During this task the woman seeks health care and cultural practices. B This process continues throughout pregnancy as the woman reworks relationships. C This task occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food or presents. D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real and feelings of love and attachment surge.

When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during pregnancy, the woman responds, I dont like milk. What dietary adjustments could the nurse recommend? a. Increase intake of organ meats. b. Eat more green leafy vegetables. c. Choose more fresh fruits, particularly citrus fruits. d. Include molasses and whole-grain breads in the diet.

b. Eat more green leafy vegetables. For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones. Page 60

An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal care and counseling for adolescents different from other age populations? a. A pregnant adolescent is experiencing two major life transitions at the same time. b. Adolescents who get pregnant are more likely to have other chronic health problems. c. Adolescents are at greater risk for multifetal pregnancies. d. At this age, a pregnant adolescent will accept the nurses advice

a. A pregnant adolescent is experiencing two major life transitions at the same time. The pregnant adolescent must cope with two of lifes most stress-laden transitions simultaneously: adolescence and parenthood. Page 69

During the physical examination for the first prenatal visit, it is noted that Chadwicks sign is present. What is Chadwicks sign? a. Bluish or purplish discoloration of the vulva, vagina, and cervix b. Presence of early fetal movements c. Darkening of the areola and breast tenderness d. Palpation of the fetal outline

a. Bluish or purplish discoloration of the vulva, vagina, and cervix Chadwicks sign is the purplish or bluish discoloration of the cervix and vagina. Page 49

After the examination is completed, the patient asks the nurse why Chadwicks sign occurs during pregnancy. What would the nurse explain as the cause of Chadwicks sign? a. Enlargement of the uterus b. Progesterone action on the breasts c. Increasing activity of the fetus d. Vascular congestion in the pelvic area

d. Vascular congestion in the pelvic area Chadwicks sign is caused by increased vascular congestion in the cervical and vaginal area. Page 49

What nursing interventions are appropriate for the prenatal patient in terms of prenatal care? (Select all that apply.) a. Offer nutritional counseling. b. Reinforce responsibility of parenthood. c. Reduce risk factors. d. Improve health practices. e. Make financial arrangements for delivery.

a. Offer nutritional counseling. b. Reinforce responsibility of parenthood. c. Reduce risk factors. d. Improve health practices. ANS: A, B, C, D Nutritional counseling, reinforcing and discussing the responsibility of parenthood, reducing risk factors for the pregnant woman and the fetus, and improving health practices are all goals of prenatal care. Page 44-45

The nurse recognizes which behavior characteristic(s) of women in their first trimester of pregnancy? (Select all that apply.) a. Showing off her sonogram photos b. Ambivalence about pregnancy c. Emotional and labile mood d. Focusing on her infant e. Fatigue

a. Showing off her sonogram photos b. Ambivalence about pregnancy c. Emotional and labile mood e. Fatigue ANS: A, B, C, E Showing off photos, feeling ambivalence about the pregnancy, fragile emotions, and fatigue and sleepiness are all characteristic of behaviors seen in the first trimester. Women are not focused on their infant; they are focused on themselves and the physical changes they are experiencing. Page 67

A woman who is 37 weeks pregnant reports feeling dizzy when lying on her back. What does the nurse explain as the most likely cause of this symptom? a. Supine hypotension syndrome b. Gestational diabetes c. Pregnancy-induced hypertension d. Malnutrition

a. Supine hypotension syndrome Supine hypotension syndrome, also called aortocaval compression or vena cava syndrome, may occur if the woman lies on her back. Symptoms of supine hypotension syndrome include faintness, lightheadedness, dizziness, and agitation. Page 53

The nurse cautions the patient that, because of hormonal changes in late pregnancy, the pelvic joints relax. What does this result in? (Select all that apply.) a. Waddling gait b. Joint instability c. Urinary frequency d. Back pain e. Aching in cervical spine

a. Waddling gait b. Joint instability ANS: A, B A waddling gait and joint instability are the only signs that relate to joint changes. The other discomforts are related to the enlarging uterus with its attendant weight. Page 55

A woman pregnant for the first time asks the nurse, When will I begin to feel the baby move? What is the nurses best response? a. You may notice the baby moving around the 4th or 5th month. b. Quickening varies with every woman. c. Youll feel something by the end of the first trimester. d. The baby will be big enough for you to feel in your 8th month.

a. You may notice the baby moving around the 4th or 5th month. Quickening, fetal movement felt by the mother, is first perceived at 16 to 20 weeks of gestation. Page 49

A pregnant woman is attending her second postpartum visit. Prenatal lab work indicates she is not immune to the rubella virus. What is the most appropriate nursing intervention? a. Provide the rubella vaccine as ordered by the physician immediately. b. Inform the woman she should receive the vaccine in the hospital after delivery. c. Hold all immunizations until 1 month postpartum. d. Encourage the patient to decide whether or not to get the rubella vaccine prenatally.

b. Inform the woman she should receive the vaccine in the hospital after delivery. The rubella vaccine is contraindicated during pregnancy. A woman should be instructed to avoid pregnancy for at least 1 month following rubella immunization. It is not necessary to hold all immunizations until 1 month postpartum. Page 72

The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? a. Blood pressure goes up toward the end of pregnancy. b. My breathing will get deeper and a little faster. c. Ill notice a decreased pigmentation in my skin. d. There will be a curvature in the upper spine area.

b. My breathing will get deeper and a little faster. The pregnant woman breathes more deeply, and her respiratory rate may increase slightly. Page 52

At her initial prenatal visit a woman asks, When can I hear the babys heartbeat? At what gestational age can the fetal heartbeat be auscultated with a specially adapted stethoscope or fetoscope? a. 4 weeks b. 12 weeks c. 18 weeks d. 24 weeks

c. 18 weeks The fetal heartbeat can be heard with a fetoscope between the 18th and 20th weeks of pregnancy. Page 50

A womans prepregnant weight is determined to be average for her height. What will the nurse advise the woman regarding recommended weight gain during pregnancy? a. 10 to 20 pounds b. 15 to 25 pounds c. 25 to 35 pounds d. 28 to 40 pounds

c. 25 to 35 pounds The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds. Page 57

A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? a. Eat three well-balanced meals per day and limit snacks. b. Drink a full glass of fluid at the beginning of each meal. c. Have crackers handy at the bedside, and eat a few before getting out of bed. d. Eat a bland diet and avoid concentrated sweets.

c. Have crackers handy at the bedside, and eat a few before getting out of bed. The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy. Page 65, Table 4-6

A woman reports that her last normal menstrual period began on August 5, 2013. What is this womans expected delivery date using Ngeles rule? a. April 30, 2014 b. May 5, 2014 c. May 12, 2014 d. May 26, 2014

c. May 12, 2014 To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual period, then add 7 days and change the year if necessary. Page 48, Box 4-2

The patient remarks that she has heard some foods will enhance brain development of the fetus. The nurse replies that foods high in docosahexaenoic acid (DHA) are thought to enhance brain development. What food can the nurse recommend? a. Fried fish b. Olive oil c. Red meat d. Leafy green vegetables

c. Red meat Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA. Page 55

A woman who is 36 weeks pregnant tells the nurse she plans to take a 12-hour flight to Hawaii. What would the nurse recommend that the patient do during the flight? (Select all that apply.) a. Wear tight-fitting clothing to promote venous return. b. Eat a large meal before boarding the flight. c. Request a seat with greater leg room. d. Drink at least 4 ounces of water every hour. e. Get up and walk around the plane frequently.

c. Request a seat with greater leg room. d. Drink at least 4 ounces of water every hour. e. Get up and walk around the plane frequently. ANS: C, D, E Because of the increase in clotting potential, the pregnant patient is prone to a thromboembolism. Adequate hydration, frequent position changes, and movement decrease the risk. Page 64-65

The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurses initial action? a. Assess food intake. b. Weigh the patient again. c. Take the blood pressure. d. Notify the physician.

c. Take the blood pressure. The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician. Page 53

At what age is a woman who becomes pregnant for the first time described as an elderly primip? a. After 25 years old b. After 28 years old c. After 30 years old d. After 35 years old

d. After 35 years old A woman over the age of 35 who becomes pregnant for the first time is described as an elderly primip. Page 69

A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy? a. Amenorrhea b. Uterine enlargement c. HCG detected in the urine d. Fetal heartbeat

d. Fetal heartbeat Positive indications are caused only by the developing fetus and include fetal heart activity, visualization by ultrasound, and fetal movements felt by the examiner. Page 50

The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy. What is the appropriate term for this sign? a. Chadwicks b. Hegars c. McDonalds d. Goodells

d. Goodells Goodells sign is one of the probable signs of pregnancy and describes a softened cervix and vagina. Page 49

In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. What is the nurses first action? a. Ask if the patient has taken a sedative. b. Notify the physician. c. Turn the patient to her right side. d. Record the rate as a normal finding.

d. Record the rate as a normal finding. The FHR at term ranges from a low of 110 to 120 beats/min to a high of 150 to 160 beats/min. This should be recorded as normal. The FHR drops in the late stages of pregnancy. Page 50