Chapter 7: Prenatal Care

Which question should the nurse include when conducting a review of systems with a patient during the first prenatal visit? "Do you have a peptic ulcer?" "Have you ever had a heart attack?" "Have you had any neurologic diseases?" "Have you had any urinary tract infections?"

"Have you had any urinary tract infections?"

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern? "I am not sure if I want to keep the baby. It is a hard decision." "I am unsure who the father of the baby is. I will be raising it alone." "I needed Rho(D) immune globulin after my last pregnancy. Will I need it again?" "I only want my family to see the baby after it is born."

"I am unsure who the father of the baby is. I will be raising it alone."

A client at 10 weeks' gestation is complaining of ptyalism over the past 2 weeks. What intervention would the nurse recommend to this client? Select all that apply. Chew gum. Use saline nasal spray. Wear a panty liner. Eat a large, protein rich meal in the evening. Suck on hard candies.

Chew gum Suck on hard candies.

A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history? Ask her to complete a written questionnaire concerning her past and present status. Conduct an interview in a private room to obtain her health history. Wait until she is in the examining room and prepared for her physical examination. Ask her some basic questions in the waiting room before taking her to the examining room.

Conduct an interview in a private room to obtain her health history.

Some pregnant women hire a trained professional to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who takes this role? partera doula midwife pregnancy aide

Doula

The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide? Ask the client to respond to a preprinted survey about nursing care. Interview the client on her first postpartum visit about the nursing care she have received. Identify the nursing diagnoses for the specific client. Verify that desired outcomes for identified goals have been met.

Verify that desired outcomes for identified goals have been met.

Which disease process would the nurse screen for under potential genetic disorders? tuberculosis rheumatic fever cystic fibrosis asthma

Cystic fibrosis

A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information? gravida 3, para 2 gravida 3, para 3 gravida 4, para 2 gravida 4, para 3

gravida 4, para 2

A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant woman. What does the nurse explain is the main difference when an incarcerated client comes to the clinic? The woman will receive limited prenatal care. The woman will have follow-up appointments at the prison. There is no difference when incarcerated women come to the clinic. There will be correction officers with the woman throughout her appointment. The woman will be handcuffed and wearing shackles during her appointment.

There will be correction officers with the woman throughout he appointment

As part of the assessment of a client's health history during the first prenatal visit, the nurse is having the client complete a 24-hour recall to establish what and how much the woman is eating. In which section of the health history should the nurse record this information? day history/social profile demographic data history of past illnesses chief concern

Day history/ social profile

While conducting the first prenatal health history visit, the nurse learns that a pregnant client is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the client at this time? risk for injury to fetus related to lifestyle choices deficient knowledge regarding exposure to teratogens during pregnancy health-seeking behaviors related to strong cultural desire to have a healthy child health-seeking behaviors related to guidelines for nutrition and activity during pregnancy

Deficient knowledge regarding exposure to teratogens during pregnancy.

A 20-year-old woman you see in a prenatal clinic has an accessory nipple. Which teaching point would be most important to make with her? The tendency for accessory nipples is familial. Such growths fade with menopause. Bleeding from such growths is not uncommon. Such growths deepen in color during pregnancy.

Such growths deepen in color during pregnancy,

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? 24 cm 12 cm 16 cm 20 cm

20 cm

Why is the first prenatal visit usually the longest prenatal visit? Laboratory tests are performed. Baseline data is collected. A pelvic exam with Papanicolaou test is performed. Extensive client teaching is done.

Baseline data is collected

A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of prenatal care? Select all that apply. Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Maximize the risk of possible complications. Identify women at risk for complications. Increase the business of the clinic.

Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Identify women at risk for complications.

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse? Promotes clearing mucus from the respiratory tract Assists with ciliary body maturation in the upper airways Helps the lungs remain expanded after the initiation of breathing Helps maintain a rhythmic breathing pattern

Helps the lungs remain expanded after the intiation of breathing.

A nurse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply. Individualized assessment Assistance with social coordination Counseling Authoritarian decision making Teaching

Individualized assessment Counseling Teaching

The nurse is caring for a client having chorionic villus sampling using the transcervical approach. When preparing the client for the procedure, in which position is the client placed? supine position recumbent position Sims position lithotomy position

Lithotomy position

The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation? Intrauterine growth retardation Multiple fetal pregnancy Deficient amniotic fluid Urinary retention

Multiple fetal pregnancy

The nurse is documenting subjective and objective data changes from a client at 34 weeks' gestation. Which would the nurse report immediately to the health care provider? Select all that apply. Difficulty sleeping Feeling faint Bleeding gums Frequent nosebleeds Scant spotting on underwear Sharp abdominal pain

Scant spotting on underwear sharp abdominal pain

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 10. Which nursing action is best? Notify the health care provider immediately. Schedule a health care provider appointment for one week. Tell the client to report to the hospital for a nonstress test. Prepare all records as the client will be admitted for a cesarean birth.

Schedule a health care provider appointment for one week.

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

Stretching and breathing exercises such as yoga

The nurse receives a call from a concerned client, who is 39 weeks' gestation, indicating the woman has "blood-tinged mucus seeping from the vagina." What does the nurse understand about this? The woman should rest on her left side and drink water. This is known as "bloody show" and is a normal finding at this time. The woman has likely been overly active, and should be evaluated for complications. This is known as Braxton Hicks contractions and is not a concern at this time.

This is known as "bloody show" and is a normal finding at this time.

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? cardiocentesis amniocentesis nuchal translucency testing chorionic villus sampling

amniocentesis

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? "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy." "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully." "Sexually transmitted infections are much more common than most people believe."

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."

A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful? "If my AFP level is high, it could mean there is a problem with my baby's spinal cord." "If my AFP level is negative, it means the baby has no birth defects." "If my AFP level is low, then I won't need to follow up." "If there is a need to get my AFP level tested, a blood sample will be obtained around 11 weeks."

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord."

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." "I should call the doctor if I have any vaginal bleeding." "A sudden rush of fluid means that my membranes ruptured. "I should not worry if I vomit once a day for the first 12 weeks."

"Pain with urination is expected during pregnancy."

A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." "As long as you do not increase the amount of alcohol you are drinking there is little risk." "The best thing for you to do is to reduce the amount of alcohol you are drinking."

"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."

A 24-year-old childcare worker comes to the clinic for her first prenatal visit. She cannot remember when her last period was but thinks it was between 2 and 5 months ago. When she began gaining weight and feeling "odd" she did a home pregnancy test, which was positive. She states she felt fetal movements about 1 week ago. She has had no nausea, vomiting, fatigue, or fevers. Past medical history is remarkable for irregular periods. She has been dating the same man for 1 year and says they did not use condoms. Examination reveals an overweight young woman who appears her stated age. Head, eyes, ears, nose, throat, neck, thyroid, cardiac, and pulmonary examinations are unremarkable. The client's abdomen is nontender with normal bowel sounds, and the gravid uterus is palpated to the level of the umbilicus. Fetal tones are easily found with Doptone; with the fetoscope a faint heart rate of 140 is audible. By speculum examination the cervix is bluish; by bimanual examination the cervix is soft. Papanicolaou test, cultures, and blood work are pending. The nurse gives the client her due date and how far along she is based on clinical findings. An obstetric ultrasound to confirm her dates is ordered. Based only on the clinical examination findings, how many weeks pregnant did the nurse tell this client she was? 6 to 8 weeks 12 to 14 weeks 18 to 20 weeks 24 to 26 weeks

18 to 20 weeks

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: January 30 December 30 December 16 November 23

December 30

A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment? history of exercising twice a week history of diabetes for 4 years history of occasional use of OTC pain relievers maternal age of 28 years

History of diabetes for 4 years

When explaining what will occur during the first prenatal visit physical examination, a pregnant client asks why a Papanicolaou test is being done at this time. What should the nurse respond to the client? It helps to date the pregnancy. It detects if uterine cancer is present. It predicts whether cervical cancer will occur. It detects cancer cells of the cervix, vulva, or vagina.

It detects cancer cells of the cervix, vulva, or vagina.

A nurse working in a correctional facility is monitoring a group of pregnant inmates. Which interventions might be necessary to improve the health of these incarcerated pregnant women? Select all that apply. Provide prenatal vitamins Ensure frequent hydration Recommend activity restrictions Provide comprehensive prenatal care Coordination of care with off-site providers Provide extra food and exclude unpasteurized items

Provide prenatal vitamins Ensure frequent hydration Recommend activity restrictions Coordination of care with off-site providers Provide extra food and exclude unpasteurized items

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

The first day of her last menstrual period.

A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction? "Increasing my water intake will aid in reducing my constipation." "Taking gentle enemas no more frequently than once a week is acceptable." "Adding more vegetables to my diet will be helpful." "Exercise such as walking daily helps increase my bowel movements."

"Taking gentle enemas no more frequently than once a week is acceptable."

At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse? "This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." "This is a diagnostic test to identify insulin resistance during pregnancy." "Yes. If the results of your blood work are elevated you have gestational diabetes and will be started on insulin." "No, this is part of the routine prenatal lab work. The test for gestational diabetes will be done during your third trimester."

"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."

A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse? "Fetal movements can be felt at 13 weeks." "You should start to feel fetal movements within the next few weeks." "You usually cannot feel them until approximately 16 to 20 weeks." "You won't be able to feel movements until you lie down and concentrate on them."

"You usually cannot feel them until approximately 16 to 20 weeks."

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply. Limit fluid intake to 1 liter daily. Complete moderate exercise daily. Wear compression stockings. Keep legs below the level of the heart. Avoid sudden position changes.

Complete moderate exercise daily. Wear compression stockings.

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

Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and hen weekly until the birth.

The nurse is planning a class for nurses learning to teach early prenatal classes. Which statement indicates that teaching has been effective? Early prenatal care is needed for a healthy newborn. The goal of early prenatal care is to optimize the health of the woman and the fetus. The first prenatal visit should be as soon as the woman misses her period. Early prenatal care is meant to obtain laboratory work and teach the woman regarding danger signs early in the pregnancy.

The goal of early prenatal care is to optimize the health of the woman and the fetus.

A client at 6 weeks' gestation asks if she can listen to the fetal heart sounds. The nurse informs the client that fetal heart sounds cannot be heard with a Doppler until when? 8 weeks 10 to 12 weeks 18 to 20 weeks 24 weeks

10 to 12 weeks

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history? G3 P0020 G2 P0020 G2 P1020 G3 P0021

G3 P0020

A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2 G2, T0, P1, A1, L1

G3, T0, P1, A1, L1

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 18 cm 24 cm 30 cm 32 cm

24 cm

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. 3, 2, 1, 2, 1 4, 2, 2, 1, 1 3, 2, 1, 1, 1 4, 1, 1, 1, 1

4, 1, 1, 1, 1

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as: G = 4, T = 2, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1

G = 3, T = 1, P = 0, A = 1, L = 1

A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2 G2, T0, P1, A1, L1

G2, T0, P1, A1, L1

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? hemoglobin and hematocrit urine for culture fetal ultrasound fundal height measurement

Fundal height measurement

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready? Ultrasound equipment Sterile field with scalpel Foley catheter Sterile urine cup

Ultrasound equipment

The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care? Use hot water and a mild soap to keep the nipples clean. Wash the nipples with a deodorant soap to keep them clean and help toughen them. Use an antibacterial soap and cool water to keep the nipples clean. Wash the nipples with clean water only.

Wash the nipples with clean water only.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate? "Do you have old paint in the house?" "Do you use well water for drinking?" "Do you lock your medications in a cabinet:" "Do you have a cat in the house?"

"Do you have a cat in the house?"

A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation? 20 weeks 24 weeks 28 weeks 32 weeks

24 weeks

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: 4 weeks. 3 weeks. 2 weeks. 1 week.

4 weeks

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record? Amniocentesis, chorionic villus sampling, fetal nonstress test Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Fetal nonstress test, Doppler assessment of fetal heart rate Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling

During pregnancy, the cardinal rule concerning medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy? asthma gout cholelithiasis gastritis

Asthma

The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the woman's diet? Yogurt and low-fat milk Green leafy vegetables Oily fish such as salmon Green and iced tea

Green leafy vegetables

The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility? Hypothyroidism Hemolytic anemia Electrolyte deficiencies Abnormal bleeding

Hemolytic anemia

A woman reports that her last menstrual period (LMP) occurred February 1, 2017. Using the Naegele rule, what would be her estimated date of delivery (EDD)? November 8, 2018 November 8, 2017 October 1, 2018 October 1, 2017

November 8, 2017

The nurse is assessing a woman who is pregnant for the first time. Which of the following terms applies to this client? primigravida primipara nulligravida multipara

Primigravida

Which two tests are generally performed on urine at a prenatal visit? protein and sodium pH and glucose occult blood and protein protein and glucose

Protein and glucose

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. This occurs about 4 or 5 times during the testing period. The nurse interprets this as: variable decelerations. fetal tachycardia. a nonreactive pattern. reactive pattern.

Reactive pattern

A nursing student correctly identifies which action to be the best way to prevent complications of pregnancy? limiting work hours receiving prenatal care getting adequate rest each night eating a diet high in protein

Receiving prenatal care

The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a blood test to detect placental problems. The BPP is a screening for neural tube defects. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

The BPP is an ultrasound that measures breathing, body movement, tone and amniotic fluid volume.