Chapter 4 (antepartum) LP 6

3. When analyzing the need for health teaching of a prenatal multigravida, the nurse should ask which of the following questions? 1. "What are the ages of your children?" 2. "What is your marital status?" 3. "Do you ever drink alcohol?" 4. "Do you have any allergies?"

Do you ever drink alcohol?

5. Because N/V are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Drink 2 glasses of water with each meal. 4. Eat 3 large meals plus a bedtime snack.

1. Avoid eating greasy foods. 2. Saltine crackers should be eaten before rising. Drinking orange juice is not recommended. 3. It is recommended that liquids and solids be eaten separately. 4. It is recommended that mothers eat small frequent meals throughout the day. TEST-TAKING TIP: Although many women experience nausea and vomiting or morning sickness upon rising, many women complain of nausea and/or vomiting at other times of the day. One theory that has been offered to explain this problem is that the body is ridding itself of teratogens that could potentially harm the fetus.

66. A nurse is advising a pregnant woman about the danger signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? Select all that apply. 1. Convulsions. 2. Double vision. 3. Epigastric pain. 4. Persistent vomiting. 5. Polyuria.

1. Convulsions 2. Double vision 3. Epigastric pain (1-3 symptoms of the hypertensive illnesses) 4. Persistent vomiting (symptom of hyperemesis gravidarum)

58. A gravid woman who recently emigrated from mainland China is being seen at her first prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy? 1. Influenza. 2. Mumps. 3. Rubella. 4. Varicella.

1. Influenza. (The nasal spray, however, should not be administered to a pregnant woman.

7. A gravida, G1 P0, is having her first prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? 1. Pap smear. 2. Mammogram. 3. Glucose challenge test. 4. Biophysical profile

1. Pap smear.

55. During a preconception counseling session, the nurse encourages a couple to prepare a birth plan. Which of the following is the most important goal for this action? 1. Promote communication between the couple and health care professionals. 2. Enable the couple to learn about the types of medicine used in labor. 3. Provide the couple with a list of items that they should put in a bag for labor. 4. Give the high-risk couple a sense of control over having to have a cesarean.

1. Promote communication between the couple and health care professionals.

90. A woman asks the nurse about the function of amniotic fluid. Which of the following statements by the woman indicates that additional teaching is needed? 1. The fluid provides fetal nutrition. 2. The fluid cushions the fetus from injury. 3. The fluid enables the fetus to grow. 4. The fluid provides a stable thermal environment.

1. The fluid provides fetal nutrition.

48. A woman is 36-weeks' gestation. Which of the following tests will be done during her prenatal visit? 1. Glucose challenge test. 2. Amniotic fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

1. The glucose challenge test is performed at approximately 24 weeks' gestation. 2. Amniotic fluid volume assessment is part of the biophysical profile (BPP). The BPP is only performed when the health care practitioner is concerned about the health and well-being of the fetus. 3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. 4. Karyotype analysis or chromosomal analysis, if performed, is done early in pregnancy

23. The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings would the nurse highlight for the physician? 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; complains of excess salivation. 4. 34 weeks' gestation; complains of hemorrhoidal pain.

2. 24 weeks' gestation; fundal height at the umbilicus.

44. A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. 1. Blood glucose. 2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. 5. Pelvic ultrasound.

2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. TEST-TAKING TIP: The test taker must read the question carefully. Although urine glucose assessments are done at each visit, blood glucoses are assessed only intermittently during the pregnancy. Similarly, although ultrasound assessments may be ordered intermittently during a pregnancy, they are certainly not done at every prenatal visit. As a matter of fact, there is no absolute mandate that a sonogram must be done at all during a pregnancy.

2. The nurse is assessing the laboratory report of a 40-week gestation client. Which of the following values would the nurse expect to find elevated above prepregnancy levels? 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin.

2. Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery. (During the latter part of the third trimester, coagulation factors increase in preparation for delivery. It is the body's means of protecting itself against a large loss of blood at delivery. Wrong: Glucose and bilirubin levels should be within normal limits. Hematocrit levels are usually slightly lower.

39. A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint? 1. Maternal hypertension. 2. Fundal height. 3. Hydramnios. 4. Congestive heart failure.

2. Fundal height. TEST-TAKING TIP: As the uterus enlarges, the woman's organs are impacted. At 36 weeks, the fundus is at the level of the xiphoid process. The diaphragm is elevated, and the lungs are displaced. When a client lies flat, she has difficulty breathing. Most women use multiple pillows at night for sleep. Whenever caring for a pregnant woman, the nurse should elevate the head of the bed.

12. A 20-year-old client states that the at-home pregnancy test that she took this morning was positive. Which of the following comments by the nurse is appropriate at this time? 1. "Congratulations, you and your family must be so happy." 2. "Have you told the baby's father yet?" 3. "How do you feel about the results?" 4. "Please tell me when your last menstrual period was."

3. "How do you feel about the results?"

16. A client makes the following statement after finding out that her pregnancy test is positive, "This is not a good time. I am in college and the baby will be due during final exams!" Which of the following responses by the nurse would be most appropriate at this time? 1. "I'm absolutely positive that everything will turn out all right." 2. "I suggest that you e-mail your professors to set up an alternate plan." 3. "It sounds like you're feeling a little overwhelmed right now." 4. "You and the baby's father will find a way to get through the pregnancy."

3. "It sounds like you're feeling a little overwhelmed right now." TEST-TAKING TIP: Nurses have two roles when clients express concerns to them. First, the nurse must acknowledge the client's concerns so that the client feels accepted and understood. Second, the nurse must help the client to problem solve the situation. It is very important, however, that the acceptance precede the period of problem solving.

64. A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2006. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2007. 2. June 20, 2007. 3. June 27, 2007. 4. July 3, 2007.

3. The estimated date of delivery is June 27, 2007 (9-3= 6 months 20+7= 27 days 2006 + 1 yr= 2007 year) Last menstrual period: subtract 3 months, add 7 days, and add 1 year.

28. A client is 15 weeks pregnant. She calls the obstetric office to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse's best response? 1. "Because the organ systems in the baby are developing right now, it is risky to take medicine." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a category "X" medication for you." 4. "You can take acetaminophen because it is a category "B" medicine."

4. "You can take acetaminophen because it is a category "B" medicine." All medications are assigned a pregnancy category from "A"—research has shown they are safe to be consumed throughout pregnancy—to "X"—a teratogenic agent. Category "B" medications are considered safe because of anecdotal evidence, although controlled research has not been conducted to confirm that evidence. Teratogens are agents that have definitely been shown to cause fetal damage.

4. A woman whose prenatal weight was 105 lb weights 109 lb at her 12 week visit. Which of the following comments by the nurse is appropriate at this time? 1. "We expect you to gain 1 lb per week, so your weight is a little low at this time." 2. "Most women gain no weight during the first trimester, so I would suggest you eat fewer desserts for the next few weeks." 3. "You entered the pregnancy well underweight, so we should check your diet to make sure you are getting the nutrients you need." 4. "Your weight gain is exactly what we would expect it to be at this time."

4. "Your weight gain is exactly what we would expect it to be at this time." (It is normal to gain 2 to 4 pounds for the entire first trimester (till 13 weeks). and then 1 lb per week from weeks 13 to 40.

82. A nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid consuming during her pregnancy? 1. Bologna. 2. Cantaloupe. 3. Asparagus. 4. Popcorn.

4. Bologna 1. Bologna (Italian pork sausage, could not be consumed during pregnancy unless it is thoroughly cooked. 2. Cantaloupe (Vitamins A and C) 3. Asparagus (vitamin K and folic acid) 4. Popcorn (fiber) might not be the healthiest fiber choice if loaded with butter and salt.

38. A 37-week gravid client states that she noticed a "white liquid" leaking from her breasts during a recent shower. Which of the following nursing responses is appropriate at this time? 1. Advise the woman that she may have a galactocele. 2. Encourage the woman to pump her breasts to stimulate an adequate milk supply. 3. Assess the liquid because a breast discharge is diagnostic of a mammary infection. 4. Reassure the mother that this is normal in the third trimester.

4. Reassure the mother that this is normal in the third trimester.

22. A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedure teaching? 1. Fast for 12 hours before the test. 2. Bring a urine specimen to the laboratory on the day of the test. 3. Be prepared to have 4 blood specimens taken on the day of the test. 4. The test should take one hour to complete.

4. The test should take one hour to complete. TEST-TAKING TIP: The GCT is done at approximately 24 weeks' gestation to assess the client's ability to metabolize glucose. It is a 1-hour, nonfasting screening test. One hour after a client consumes 50 grams of a concentrated glucose solution, a serum glucose level is done. If the value is 130 mg/dL or higher, the client is referred for a 3-hour glucose tolerance test to determine whether or not she has gestational diabetes.

1. An antenatal client is informing the nurse of her prenatal S/S of pregnancy? 1. Amenorrhea 2.Breast tenderness 3. Quickening 4. Frequent urination 5. Uterine growth

Amenorrhea, Breast tenderness, Quickening, Frequent urination

67. A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old, at 28 weeks' gestation; delivered a daughter, now 5 years old, at 39 weeks' gestation; had a miscarriage 3 years ago, and had a first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman's gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.

G5 P1122 Client has been pregnant 5 times (G5); she birthed 1 son (28 wks gestation, pre-term. 1 daughter (39 wks gestation, term. 1 miscarriage, Abortion 1 first trimester abortion, Abortion, currently pregnant. 2 living children Following para G: Gravida: Every pregnancy T: Term: ≥ 38 weeks' gestation P: Preterm 20 - 37 weeks' gestation A: Abortion: spontaneous or therapeutic L: Living children

Signs that are absolute or positive

Hearing fetal heartbeat, detecting fetal movement, and ultrasound images of the fetal outline.

69. The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods? 1. Tofu, legumes, broccoli. 2. Corn, yams, green beans. 3. Potatoes, parsnips, turnips. 4. Cheese, yogurt, fish.

Tofu, legumes, broccoli. Since animal products are most clients' sources of protein and iron

Probable (Signs that are objective, but not totally absolute

Uterine shape and size and softening of the cervix