Exam 1 - Chapter 9/14

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" What is the nurse's best response? A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." D. "You seem impatient with her. Perhaps this is precipitating her behavior."

"This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant" is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. "This is normal behavior and should begin to subside by the second trimester" is an appropriate response but it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. "You seem impatient with her. Perhaps this is precipitating her behavior" is judgmental and not appropriate. C

What is the expected delivery date for a pregnant woman whose first day of her last menstrual period was 20th April, 2014? A. 27th December, 2014 B. 20th January, 2015 C. 27th January, 2015 D. 7th February, 2016

According to Nagele's rule, the expected date of delivery is calculated by adding 7 days and 9 months to the first day of the last menstrual period. Because the patient's last menstrual period was 20th April, 2014, the expected date of delivery would be 20th April, 2014 + 9 months + 7 days = 27th January, 2015. C

A client reveals the first day of the last menstrual period (LMP) as November 25, 2014. After an assessment, the nurse confirms that the client is pregnant. What will be the estimated date of birth (EDB)? A. August 2, 2015 B. August 25, 2014 C. September 1, 2015 D. September 2, 2015

According to Nägele's rule, the estimated birth date is calculated by adding 7 days to LMP and counting forward 9 months. Hence, because the client's LMP is November 25, 2014, the expected birth date would add 9 months, so August 25, 2015, plus 7 days, which would bring the date to September 1, 2015. C

A client in the first trimester of pregnancy reports feelings of ambivalence (Mixed feelings). How does the nurse react to this finding? A. The nurse understands it as a normal response during pregnancy. B. The nurse refers the client to a support group. C. The nurse understands that it may be due to a psychologic complication. D. The nurse reports it to the primary health care provider.

Ambivalence is the phenomenon of having conflicting feelings simultaneously. This is a normal response observed in people preparing for a new role, such as parenthood. It is not necessary to refer the client to a support group, because her response is normal. The client's ambivalence is not due to any physiologic complication. This is not a condition that needs immediate medical supervision. A

A pregnant client complains of constipation. While checking the client's history, the nurse learns that the client is taking oral iron supplements. What instruction does the nurse give the client to relieve constipation? A. "Drink mineral oil before going to bed." B. "Take a stool softener before going to bed." C. "Drink six to eight glasses of water every day." D. "Discontinue taking iron supplements."

Because of their reduced gastrointestinal tract motility and intestinal compression, constipation is a common complaint among pregnant women. Gastrointestinal motility is reduced by changes in progesterone levels, which increase reabsorption of water. This in turn leads to the drying of stools, or constipation. Therefore, the nurse should instruct the client to drink six to eight glasses of water every day. During pregnancy, the nurse should not instruct the client to take mineral oil or stool softener, because they may be harmful to the fetus; these are prescribed only by the primary health care provider. Constipation may result from oral iron supplementation but the nurse should not instruct the client to stop taking iron supplementation, because iron supplements are essential to prevent anemia. C

The nurse instructs a pregnant client to wear a supportive bra. How would this intervention benefit the client? A. Arching of the back as compensation B. Improvement in respiratory status C. Reduction of pressure on the ulnar nerve D. Alleviation of disturbed body image

During pregnancy, increased breast size and weight results in increased pressure on the ulnar nerve. Hence, the nurse instructs the client to wear a supportive bra. Arching of the back is compensated for by wearing supportive shoes. Wearing a supportive bra does not improve respiratory status, because respiratory changes in pregnancy are generally due to increases in fundal height. A supportive bra is not intended alleviate disturbed body image; it is meant to relieve pressure on the ulnar nerve. C

A client in the first trimester of pregnancy tells the nurse, "I urinate frequently and am not able to hold urine even for a short time." What would the nurse suggest to ease the client's discomfort? A. "Eat dry carbohydrates." B. "Perform Kegel exercises." C. "Apply local heat or ice." D. "Get back rubs regularly."

During the first trimester of pregnancy, clients may have various discomforts such as urgent urination. Kegel exercises help strengthen the pelvic floor muscles and thus are helpful decreasing urinary urgency. Dry carbohydrates are included in the diet to suppress vomiting in pregnant women, but they have no effect on urinary urgency. Headache is also a common discomfort in a pregnant client. Massage and hot and cold application help relieve this pain. Backache during pregnancy can be eased by giving back rubs to a pregnant client. B

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she does what? A. Wiggles and points her toes during the cramp B. Applies cold compresses to the affected leg C. Extends her leg and dorsiflexes her foot during the cramp D. Avoids weight bearing on the affected leg during the cramp

Extending the leg and dorsiflexing the foot is the appropriate relief measure for a leg cramp. Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided. C

The nurse is assessing the fetal heart rate in a pregnant client. The nurse finds asynchronous fetal heartbeats during auscultation. In which condition would this finding be considered normal? A. Multifetal pregnancy B. Late pregnancy C. First pregnancy D. Surrogate pregnancy

In multifetal pregnancies, the nurse may find asynchronous fetal heartbeats during auscultation. This is because the nurse hears the heartbeats of different fetuses together. Thus, asynchronous fetal heartbeats are considered a normal sign in a client who has multiple fetuses. Asynchronous fetal heartbeats are an abnormal sign during late pregnancy, first pregnancy, and surrogate pregnancy. In these conditions, asynchronous fetal heartbeats indicate cardiac dysfunction in the fetus. A

The nurse is caring for an adolescent client who is pregnant and has conflict with the family members regarding the childbirth and future career plans. What is the best nursing intervention to help the client reduce conflict within her family? A. Refer the client to a support group. B. Refer the client to parenting classes. C. Encourage the client to verbalize her fears. D. Provide an opportunity to discuss the client's personal feelings.

Interrupted family processes due to adolescent pregnancy should be addressed carefully. Referring the client to a support group helps her develop effective problem-solving skills and reduce conflicts within her family. Referring the client to parenting classes may teach her about basic newborn care, but may not be helpful in counseling about future career options. A nursing intervention aimed at verbalizing fears helps reduce anxiety in the client. Providing an opportunity to discuss personal feelings may be an appropriate intervention for pregnant adolescents who have a disturbed body image. A

A student nurse is teaching a group of pregnant women about sibling adaptation. Which statement by one of the clients indicates a need for additional teaching? A. "Show the child how to touch the baby." B. "Exclude the child during infant feeding times." C. "Don't force interactions between the child and the baby." D. "Help the child to have realistic expectations about the baby."

It is very important to help siblings adapt to their mother's pregnancy and accept the arrival of a new baby into the family. The child shouldn't be excluded during infant feeding times, because this may cause a feeling of separation. Mothers should be encouraged to teach their children how and where to touch the baby. This encourages the child to get attached to the baby. The child should be left free while interacting with the neonate, but interactions should not be forced. The child should be encouraged to have realistic expectations about what babies are like. B

A client comes into the clinic to confirm her pregnancy and to find out her estimated day of birth (EDB). Using Naegele's rule, if December 10 was the first day of her last menstrual period (LMP), when is her EDB? A. August 10, 2014 B. August 17, 2014 C. September 10, 2014 D. September 17, 2014

Naegele's rule is a common method for calculating the EDB. It is based on the woman's accurate recall of her LMP. It assumes that the woman has a 28-day cycle and that fertilization occurred on the 14th day. According to Naegele's rule, after determining the first day of the LMP, subtract 3 calendar months and add 7 days. According to Naegele's rule, if December 10 was the first day of her last menstrual period, her estimated date of birth is September 17, 2014. D

What are probable indicators of pregnancy? Select all that apply. A. Ballottement B. Urinary frequency C. Nausea and vomiting D. Uterine enlargement E. Braxton Hicks contractions

Probable indicators of pregnancy include ballottement, uterine enlargement, Braxton Hicks contractions, placental souffle, and a positive pregnancy test. Probable indicators combined with presumptive signs strongly suggest pregnancy. Urinary frequency, nausea, and vomiting are presumptive indicators of pregnancy, and these signs alone are not reliable for the diagnosis of pregnancy. A, D, E

What are some safety measures to take while pregnant? Select all that apply. A. Use correct body mechanics. B. Avoid travel to high-altitude regions above 1000 feet. C. Perform activities requiring coordination, balance, and concentration. D. Take rest periods; reschedule daily activities to meet rest and relaxation needs. E. Avoid environmental teratogens, such as cleaning agents, paints, sprays, herbicides, and pesticides. F. Use safety features on tools and vehicles (e.g., safety seat belts, shoulder harnesses, headrests, goggles, helmets) as specified.

Safety measures to take while pregnant include the following: use correct body mechanics; avoid travel to high-altitude regions above 12,000 feet (not 1000 feet); avoid (not perform) activities requiring coordination, balance, and concentration; take rest periods and reschedule daily activities to meet rest and relaxation needs; avoid environmental teratogens, such as cleaning agents, paints, sprays, herbicides, and pesticides; and use safety features on tools and vehicles (e.g., safety seat belts, shoulder harnesses, headrests, goggles, helmets) as specified. A, D, E, F

Some men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. What is this phenomenon called? A. Quickening B. Labor syndrome C. Couvade syndrome D. Pregnancy syndrome

The phenomenon in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms is called couvade syndrome. Quickening is the mother's first perception of fetal movement. Labor syndrome and pregnancy syndrome are not part of this phenomenon. C

Which of these are presumptive indicators of pregnancy? Select all that apply. A. Dysmenorrhea B. Morning sickness C. Breast tenderness D. Urinary incontinence E. Breast and abdominal enlargement F. Skin changes, such as striae gravidarum, deeper pigmentation of the areola, melasma (mask of pregnancy), and linea nigra (pigmented line on the abdomen)

The presumptive indicators of pregnancy include: morning sickness; breast tenderness; breast and abdominal enlargement; and skin changes, such as striae gravidarum, deeper pigmentation of the areola, melasma (mask of pregnancy), and linea nigra (pigmented line on the abdomen). Amenorrhea (not dysmenorrhea) and urinary frequency (not urinary incontinence) are also presumptive indicators of pregnancy. B, C, E, F

What are the signs and symptoms of supine hypotension? Select all that apply. A. Pallor B. Acid reflux C. Dizziness D. Tachycardia E. Breathlessness F. Dry, warm skin

The signs and symptoms of supine hypotension include pallor, nausea (not acid reflux), dizziness, tachycardia, breathlessness, and cold, clammy, sweaty skin (not dry, warm skin). A, C, D, E

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A. "You don't need to modify your exercising any time during your pregnancy." B. "Stop exercising, because it will harm the fetus." C. "You may find that around the seventh month of your pregnancy, you need to modify your exercise to walking." D. "Jogging is too hard on your joints; switch to walking now."

Typically, running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise. C

The nurse is assessing the fundal height of a pregnant client. During the assessment, the nurse observes that the client has difficulty breathing and is sweating profusely. After recording the heart rate and blood pressure of the client, the nurse changes the client's position. What is the rationale for this nursing intervention? The client has: A. Excess body weight. B. Supine hypotension. C. Gestational hypertension. D. Respiratory tract infection.

While the nurse measures the fundal height, a client lies on her back. In this position, the abdominal contents may compress the vena cava or the aorta, thus causing supine hypotension. Supine hypotension is characterized by symptoms such as sweating, difficulty breathing, and tachycardia. The nurse would position the client in the lateral position until the symptoms subside. Supine hypotension may be observed in any pregnant client and it does not indicate that the client is overweight. In gestational hypertension, the client's blood pressure is elevated and is not affected by the client's position. The breathlessness developed in this condition is not caused by a respiratory tract infection. Respiratory tract infections are characterized by other signs such as fever and cough. B