Chapter 29 assessing childbearing women

A client at 26 weeks' gestation appears at the clinic for her first prenatal visit. During the health interview, she states that she has been a habitual cocaine user. The nurse understands that this client is at risk for which of the following? A) Abruptio placenta B) Thrombophlebitis C) Placenta previa D) Gestational diabetes

A

A client has just received a positive pregnancy test and is now discussing health promotion activities with the nurse. The client states, "I know I'm supposed to start gaining weight, but how much is healthy?" The nurse should tell the client that she should aim to gain how much weight during the first trimester? A) Two to four pounds B) Six to ten pounds C) Eight to twelve pounds D) Five percent of her normal body weight

A

A client who is at 23 weeks' gestation tells the nurse, "I just burn up all the time. I can't even sleep with any covers on me!" The nurse explains to the client that heat intolerance during pregnancy is primarily due to which physiologic change? A) Increased basal metabolic rate B) Decreased sweat gland activity C) Increase in maternal blood volume D) Stretching of abdominal muscles

A

A client who is in her first trimester states, "I've always been a fairly inactive person, but I'm determined to start going to exercise classes every day so my baby's as healthy as possible." How should the nurse respond to the client's statement? A) "Usually, your doctor will recommend against starting brand new exercise programs while you're pregnant." B) "Good for you. Regular physical activity tends to make labor and delivery go much smoother." C) "That's an excellent idea, and it really reduces your risk of developing high blood sugar during pregnancy." D) "Remember to start low and go slow to avoid putting stress on your baby."

A

A pregnant client asks the clinic nurse what she can use to relieve her nasal "stuffiness." The nurse bases the answer on the most likely cause of the congestion, which is attributable to which hormone? A) Estrogen B) Progesterone C) Thyroxine D) Relaxin

A

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which of the following would the nurse identify as an abnormal finding? A) Superficial bruising B) Linea nigra C) Striae D) Darkening of the umbilicus

A

The nurse is inspecting a pregnant client's cervix during a prenatal clinic visit. What is an expected assessment finding?A) Smooth cervix with a bluish tintB) Slightly rough cervix with dark pink coloration C) Pink or red cervix with small, visible nodesD) Smooth cervix with small amounts of creamy white discharge

A

A client at 32 weeks' gestation, who has had regular prenatal care, is found to have gained 6 pounds in 1 week. Which of the following would be most appropriate for the nurse to do next? A) Ask for 24-hour diet recall. B) Assess the legs for edema. C) Collect a urine culture. D) Check fundal height.

B

A client reports that she has been pregnant four times, had two babies born at term, no preterm births, two spontaneous abortions, and has two living children. The nurse should document the client's gravida and para status as which of the following? A) G2 P4202 B) G4 P2022 C) G2 P4044 D) G4 P4220

B

A woman comes to the clinic for an exam and says that she is considering trying to become pregnant in the next few months. Which of the following would the nurse encourage the client to begin taking now? A) Iron B) Folic acid C) Calcium D) Magnesium

B

During a prenatal class, a nurse teaches a client how to measure the frequency of contractions. The client demonstrates understanding with which statement? A) "I should time from when I feel the contraction to the end of the contraction." B) "I'll start timing when I feel one starting until I feel another one starting." C) "I should start timing when the contraction is the strongest until it subsides." D) "I should time from when one contraction ends and another one starts."

B

During the first prenatal examination, a woman is found to have inverted nipples. Which suggestion would be most appropriate if the woman desires to breast-feed her infant? A) Wear a supportive nursing bra during the pregnancy. B) Insert breast shields in the bra during the third trimester. C) Apply a lanolin cream to the nipples twice daily. D) Rub the nipples frequently with a rough towel.

B

The clinic nurse is assessing a client who is pregnant at 18 weeks' gestation. The nurse is obtaining a fetal heart rate using Doppler ultrasound. What fetal heart rate represents an expected finding?A) 90 beats per minute B) 130 beats per minute C) 175 beats per minute D) 225 beats per minute

B

The nurse is measuring a pregnant client's fundal height during a scheduled prenatal visit. The nurse should measure with reference to what anatomical landmarks? A) The edge of the fundus and the umbilicus B) The symphysis pubis and the fundus C) The fundus and the abdomen D) The xiphoid process and the symphysis pubis

B

A client comes to the prenatal clinic for a follow-up examination. When assessing the client's breasts, which of the following should the nurse expect to find? Select all that apply. A) Pallor of the areolae B) Prominent veins C) Nodular breasts D) Warmth E) Increased sensitivity

B,C,E

A client at 22 weeks' gestation comes to the clinic complaining of earache and decreased hearing. Otoscopic examination of the ear is normal. The nurse explains to the client that her symptoms are pregnancy-induced as a result of what physiologic change? A) Thickened, dry cerumen B) Infection of the inner ear C) Vascularity of the eardrum D) Auditory nerve compression

C

A client at 32 weeks' gestation has been placed on complete bed rest due to premature labor contractions. The nurse should prioritize assessments for which of the following complications? A) Hyperglycemia B) Urinary tract infection C) Thrombophlebitis D) Leg cramps

C

A newly pregnant client says that she has heard that her nipples will leak milk during the pregnancy. The nurse should tell the client that she should expect to be able to express colostrum from her nipples beginning at how many weeks' gestation? A) 6 to 8 B) 12 to 14 C) 24 to 28 D) 34 to 36

C

A nurse is attempting to auscultate fetal heart tones after determining that the fetus is in a longitudinal lie, cephalic presentation, and left occiput anterior position. The nurse would auscultate them at which area? A) Left upper quadrant B) Right upper quadrant C) Left lower quadrant D) Right lower quadrant

C

The nurse assesses the uterine fundus and finds it to be halfway between the symphysis pubis and the umbilicus. The nurse knows that this is an expected finding at how many gestational weeks? A) 6 B) 12 C) 16 D) 20

C

The nurse is completing a head-to-toe assessment of a pregnant client. What anatomic area should be examined when assessing the Montgomery tubercles? A) Thorax B) Abdomen C) Breasts D) Perineum

C

The nurse is completing the assessment of a client who is 26 weeks pregnant. Assessment reveals a fundal height of 21 cm. How should the nurse follow up this assessment finding? A) Have the client reassessed for gestational diabetes. B) Obtain a 24-hour food recall. C) Refer the client due to possible intrauterine growth retardation. D) Order a repeat ultrasound due to possible multiple gestation.

C

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect? A) 12 cm B) 18 cm C) 28 cm D) 32 cm

C

The nurse is palpating a pregnant client's left and right adnexa. The presence of a palpable mass should prompt the nurse to refer the client promptly for what problem? A) Abruptio placentae B) Placenta previa C) Ectopic pregnancy D) Incompetent cervix

C

The nurse is preparing to perform Leopold's maneuvers. During the first maneuver, the nurse palpates a soft mass in the upper quadrant of the abdomen. The nurse interprets this as which fetal part?A) Back B) HeadC) Buttocks D) Feet

C

The pregnant client tells the nurse she has a history of mitral valve stenosis as a sequela of rheumatic fever. The nurse plans to closely monitor the client based on the understanding that which physiologic change in pregnancy increases this client's risk for complications? A) Physiologic anemia B) Altered carbohydrate metabolism C) Increased blood volume D) Hormonal changes

C

A client at 34 weeks' gestation is lying on an examination table while the nurse asks questions. The client says she is feeling dizzy. What intervention by the nurse would be most appropriate? A) Measure orthostatic blood pressures. B) Have her get up and walk around. C) Provide her with a glass of juice. D) Turn her on her left side.

D

During the health interview of a client who has just learned that she is pregnant, the nurse is assessing the client's health history. What assessment question most directly addresses a known risk for congenital malformations? A) "Do you ever experience severe premenstrual symptoms?" B) "Do your menstrual periods tend to be irregular?" C) "Do you exercise on a regular basis?" D) "Do you have diabetes?"

D

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? A) Refer her for cardiac evaluation. B) Ask another nurse to assess the heart. C) Inquire if the client has chest pain. D) Document this and continue to follow at future visits.

D

The nurse is assessing a pregnant client and is performing Leopold's maneuvers. For the first two maneuvers, the nurse will perform which of the following actions? A) Palpate the client's midline abdomen and then the region of the symphysis pubis. B) Palpate the client's abdomen beginning with the left flank and then moving to the right flank. C) Palpate the client's floating ribs and then gradually palpate to the level of the ischial spines. D) Palpate the client's fundal region and then the lateral sides of the abdomen.

D