Exam 2 P2
Stacey has been an active runner her whole life. She's at her initial OB visit at 7 weeks and is concerned she won't be able to run while pregnant. What advice should be given to Stacey at this time? "Now that you're pregnant, you should not run until at least 6 weeks postpartum." "Now that you're pregnant, you should slow down and just walk so you don't hurt your baby." "Now that you're pregnant, you should focus on resting and avoid exercising so your baby doesn't get overheated." "Now that you're pregnant, you're fine to continue running, just be sure to stay hydrated and not run to exhaustion."
"Now that you're pregnant, you're fine to continue running, just be sure to stay hydrated and not run to exhaustion."
On examination of a full-term primipara, a labor nurse notes: active labor, right occipitoanterior (ROA), 7 cm dilated, and +3 station. Which of the following should the nurse report to the physician? 1. Descent is progressing well 2. Fetal head is not yet engaged. 3. Vaginal delivery is imminent 4. External rotation is complete
1. Descent is progressing well Descent is progressing well. The presenting part is 3 cm below the ischial spines
The nurse auscultates a fetal heart rate of 152 on a client in early labor. Which of the follow actions by the nurse is appropriate? 1. Inform the mother that the rate is normal 2. Reassess in 5 minutes to verify the results 3. Immediately report the rate to the healthcare practitioner 4. Place the client on her left side and apply oxygen by face mask
1. Inform the mother that the rate is normal
While caring for a client in the transition phase of labor, the nurse notes that the fetal monitor tracing shows average short-term and long-term variability with a baseline of 142 BPM. What should the nurse do? 1. Providing caring labor support 2. Administer oxygen via face mask 3. Change the clients position 4. Speed up the clients intravenous
1. Providing caring labor support The tracing is showing normal fetal heart tracing. No intervention is needed
While evaluating the fetal heart monitor tracing on the client in labor, the nurse notes that there are fetal heart decelerations present. Which of the following assessments must the nurse make at this time? 1. The relationship between the decelerations and the labor contractions 2. The maternal blood pressure 3. The gestational age of the fetus 4. The placement of the fetal heart electrode in relation to the fetal position
1. The relationship between the decelerations and the labor contractions The relationship between the decelerations and the contractions will determine the type of deceleration pattern
Sam is 12 weeks pregnant and has a prepregnancy BMI of 28. As the nurse educating her on nutrition and weight gain, how many total pounds should Sam be recommended to gain? 11 to 20 lbs; she is considered obese 25 to 35 lbs; she is considered to have a normal weight 12 to 25 lbs; she is considered to be overweight 28 to 40 lbs; she is considered to be underweight
12 to 25 lbs; she is considered to be overweight
A client is in the second stage of labor. She falls asleep immediately after a contraction. Which of the following actions should the nurse perform at this time? 1. Awaken the woman and remind her to push 2. Cover the woman's perineum with a sheet 3. Assess the woman's blood pressure 4. Administer oxygen to the woman via face mask
2. Cover the woman's perineum with a sheet The woman's privacy should be maintained while she is resting
A gravid client, G3 P2002, was examined 5 minutes ago. Her cervix was 8 cm dilated and 90% effaced. She now states that she needs to be move bowels. Which of the following actions should the nurse perform first? 1. Offer the client the bedpan 2. Evaluate the progress of labor 3. Notify the physician 4. Encourage the patient to push
2. Evaluate the progress of labor The nurse should first assess the progress of the labor to see if the client has moved into the second stage of labor
Clint who is 7 cm dilated and 100% effaced is breathing at a rate of 50 breaths per minute during contractions. Immediately after a contraction, she complains of tingling in her fingers and some light-headedness. Which of the following actions should the nurse take at this time? 1. Assess the blood pressure 2. Have the woman breathe into a bag 3. Turn the woman onto her side 4. Check the fetal heart rate
2. Have the woman breathe into a bag The client is showing signs of hyperventilation. The symptoms will likely subside if she rebreathes her exhalations.
In addition to breathing with contractions, the nurse should encourage women in first stage of labor to perform which of the following therapeutic actions? 1. Lying in the lithotomy position 2. Performing effleurage 3. Practicing kegal exercises 4. Pushing with each contraction
2. Performing effleurage Effleurage is a light massage that can soothe the mother during labor
Tasha is experiencing increased energy, her urinary frequency has subsided, and she is starting to focus on her birth plan. What gestational age is Tasha most likely in at this time? 11 weeks 22 weeks 34 weeks 4 weeks
22 weeks
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? 10 to 20 pounds 15 to 25 pounds 25 to 35 pounds 28 to 40 pounds
25 to 35 pounds The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds.
The nurse knows that which of the following responses is the primary rationale for the inclusion of the information taught in childbirth education classes? 1. Mothers who are performing breathing exercise during labor refrain from yelling 2. Breathing and relaxation exercises are less exhausting than crying and moaning 3. Knowledge learned at childbirth education classes helps to break the fear-tension- pain cycle. 4. Childbirth education classes help to promote positive maternal-newborn
3. Knowledge learned at childbirth education classes helps to break the fear-tension- pain cycle. Some of the techniques learned in childbirth education classes are meant to break the fear-tension- pain cycle
When performing Leopold maneuvers, the nurse notes the the fetus is in the left occiput anterior position. Which is the best position for the nurse to place a fetoscope to hear the fetal heartbeat? 1. Left upper quadrant 2. Rigt upper quadrant 3. Left lower quadrant 4. Right lower quadrant
3. Left lower quadrant The fetoscope should be placed in the left lower quadrant for a fetus positioned in the LOA position as described in the question.
The nurse is caring for a nulliparous client who attended Lamaze childbirth education classes. Which of the following techniques should the nurse include in her plan of care? Select all that apply 1. Hypnotic suggestion 2. Rhythmic chanting 3. Muscle relaxation 4. Pelvic rocking 5. Abdominal massage
3. Muscle relaxation 4. Pelvic rocking 5. Abdominal massage Historically, Lamaze focuses on breathing techniques during labor and birth, as well as education on movement and position, massage, relaxation, and use of heat and cold in addition to the traditional focused-breathing techniques.
The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse concludes that the fetus is likely in which of the following positions? 1.Mentum anterior. 2.Sacrum posterior. 3.Occiput posterior. 4.Scapula anterior.
3. Occiput posterior. When a fetus is in the occiput posterior position, a mother frequently complain of server back pain.
A client is complaining of serve back labor. Which of the following nursing interventions would be most effective? 1. Assist mother with childbirth breathing 2. Encourage mother to have an epidural 3. Provide direct sacral pressure 4. Move the woman to a hydrotherapy tub
3. Provide direct sacral pressure When direct sacral pressure is applied, the nurse is providing a counteraction to the pressure being exerted by the fetal head.
The Lamaze childbirth educator is teaching a class of pregnant couples the berthing technique that is most appropriate during the second stage of labor. Which of the following techniques did the nurse teach the women to do? 1. Alternately pant and blow 2. Take rhythmic, shallow breaths 3. Push done with an open glottis 4. Do slow chest breathing
3. Push done with an open glottis Open glottal pushing is used during stage 2 of labor
A nurse is teaching childbirth education classes to a group of pregnant teens. Which of the following strategies would promote learning by the young women? 1. Avoiding the discussion of uncomfortable procedures like vaginal examinations and blood tests 2. Focusing the discussion on baby care rather than on labor and delivery 3. Utilizing visual aids like movies and posters during classes 4. Having the classes at a location other than high school to reduce their embarrassment
3. Utilizing visual aids like movies and posters during classes Using visual aids can help to foster learning in teens as well as adults
One hour ago, a multipara was examined with the following results: 8 cm, 50% effaced, and +1 station. She is now pushing with contractions and the fetal heal is seen at the vaginal Introits. The nurse concluded the client is now: 1. 9cm dilated, 70% effaced , and +2 station 2. 9 cm dilated, 80% effaced, and +3 station 3. 10 cm dilated, 90% effaced, and +3 station 4. 10 cm dilated, 100% effaced, and +5 station
4. 10 cm dilated, 100% effaced, and +5 station The cervix is fully dilated and fully effaced and the baby is enough to be seen through the vaginal introitus
A woman, G2 P0101, 5 cm dilated, and 30% effaced, is doing first-level Lamaze breathing with contractions. The nurse detects that the woman's shoulder and face muscles are beginning to tense during the contractions. Which of the follow interventions should the nurse perform first? 1. Encourage the women to have an epidural 2. Encourage the woman to accept intravenous analgesia 3. Encourage the woman to change her position 4. Encourage the woman to perform the next level breathing
4. Encourage the woman to perform the next level breathing This woman is in the active phase of labor. The first phase breathing is probably no longer effective. Encouraging her to shift to the next level of breathings appropriate at this time.
The nurse documents in a laboring woman's chart that the fetal heart is being "assessed via intermittent auscultations". To be consistent with this statement, the nurse, using a Doppler electrode, should assess the fetal heart at which of the following times? 1. After every contraction 2. For 10 minutes every half hour 3. Only during the peak of contractions 4. For 1 minute immediately after contractions
4. For 1 minute immediately after contractions Intermittent auscultation should be performed for 1 full minute after contractions end
A nurse is teaching a class of pregnant couples the most therapeutic Lamaze breathing technique for the latent phase of labor. Which of the following techniques did the nurse teach? 1. Alternately panting and blowing 2. Rapid, deep breathing 3. Grunting and pushing with contractions 4. Slow chest breathing
4. Slow chest breathing Most women find slow chest breathing effective during the latent phase
Which of the following patients may need a nutritional consult and dietary follow-up? A G2P1001 patient who is 24 weeks and 3 days along, 23 years old with a BMI of 21 and has gained 8 pounds so far. A G3P1102 patient who is 31 weeks and 1 day along, 29 years old with a BMI of 29 and has gained 38 pounds so far. A G1P0 patient who is 39 weeks and 0 days along, 34 years old with a BMI of 22 and has gained 24 pounds so far. A G6P4105 patient who is 12 weeks and 3 days along, 31 years old with a BMI of 19 and has gained 3 pounds so far.
A G3P1102 patient who is 31 weeks and 1 day along, 29 years old with a BMI of 29 and has gained 38 pounds so far.
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 pregnant adolescent is experiencing two major life transitions at the same time. Adolescents who get pregnant are more likely to have other chronic health problems. Adolescents are at greater risk for multifetal pregnancies. 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.
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? You may notice the baby moving around the 4th or 5th month. Quickening varies with every woman. Youll feel something by the end of the first trimester. 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
In a prenatal education, the nurse is reviewing the importance if using relaxation techniques during labor. Which patient statement will the nurse need to correct? A: "we will practice relaxation techniques only in a quiet setting so I can focus" B: "relaxation is important during labor because it will help me conserve my energy" C: "if I relax in between contractions, my baby will get more oxygen during labor" D: "my partner and I will practice relaxation throughout the remainder of my pregnancy"
A: "we will practice relaxation techniques only in a quiet setting so I can focus" Relaxation exercises must be practiced frequently to be useful during labor. Couples begin practice sessions in a quiet, comfortable setting. Later, they practice in other places that simulate the noise and unfamiliar setting of the hospital. The ability to relax during labor is an important component of coping effectively with childbirth. Relaxation conserves energy, decreases oxygen use, and enhances other pain relief techniques. Women learn exercises to help them recognize and release tension. The labor partner assists the woman by providing feedback during exercise sessions and labor.
During the physical examination for the first prenatal visit, it is noted that Chadwicks sign is present. What is Chadwicks sign? Bluish or purplish discoloration of the vulva, vagina, and cervix Presence of early fetal movements Darkening of the areola and breast tenderness Palpation of the fetal outline
A: Chadwicks sign is the purplish or bluish discoloration of the cervix and vagina.
Which complaint made by a patient at 35 weeks of gestation requires additional assessment? A: abdominal pain B: ankle edema in the afternoon C: backache with prolonged standing D: shortness of breath when climbing stairs
A: abdominal pain Abdominal pain at 35 weeks gestation may indicate preeclampsia, or abruptio placentae. Ankle edema in the afternoon is a normal finding at this stage of the pregnancy. Backaches while standing is a normal finding in the later stages of pregnancy. Shortness of breath is an expected finding at 35 weeks.
A nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. Which of the following findings should the nurse include? (Select all that apply) A: breast tenderness B: urinary frequency C: epistaxis D: dysuria E: epigastric pain
A: breast tenderness B: urinary frequency C: epistaxis Breast tenderness, urinary frequency, and epistaxis are common discomforts that occur during the first trimester of pregnancy.
When a pregnant woman develops ptyalism, which guidance should the nurse provide? A: chew gum or suck on lozenges between meals B: eat nutritious meals that provide adequate amounts of essential vitamins and minerals C: take short walks to stimulate circulation in the legs and elevate the legs periodically D: use pillows to support the abdomen and back during sleep
A: chew gum or suck on lozenges between meals Some women experience ptyalism, or excessive salivation. The cause of ptyalism may be decreased swallowing associated with nausea or stimulation of the salivary glands by the ingestion of starch. Small frequent meals and use of chewing gum and oral lozenges offer limited relief for some women. All other options include recommendations for pregnant women; however, they do not address ptyalism.
Which factors contribute to the presence of edema in the pregnant patient? (Select all that apply.) A: diet consisting of processed foods B: hemoconcentration C: increase in colloid osmotic pressure D: last trimester of pregnancy E: decreased venous return
A: diet consisting of processed foods D: last trimester of pregnancy E: decreased venous return Processed foods, which are high in sodium content, can contribute to edema formation. As the pregnancy progresses, because of the weight of the uterus, compression takes place, leading to decreased venous return and an increase in edema formation. A decrease in colloid osmotic pressure would contribute to edema formation and fluid shifting. Hemodilution would also lead to edema formation.fa davis ch
The labor nurse is reviewing breathing techniques with a primiparous patient admitted for induction of labor. When is the best time to encourage the laboring patient to use slow, deep chest breathing with contractions? A: during labor, when she can no longer talk through contractions B: during the first stage of labor, when the contractions are 3-4 minutes apart C: between contractions, during the transitional phase of the first stage of labor D: between her efforts to push to facilitate relaxation between contractions
A: during labor, when she can no longer talk through contractions Focused breathing techniques should not be used in labor until they are actually needed, which is usually when the woman can no longer walk and talk during a contraction. If breathing techniques are used too early, the woman tends to move through the different techniques too quickly, and she may stop using them. In addition, the use of the more complex breathing patterns in latent labor may increase fatigue. Women should be encouraged to adapt the techniques to their own comfort and needs. Breathing deeply between contractions or pushing can increase the possibility of carbon dioxide retention and make the patient dizzy.
Which lab result would be a cause for concern if exhibited by a patient at her first prenatal visit during the second month of her pregnancy? A: rubella titer, 1:6 B: platelets, 300,000/mm3 C: white blood cell count, 6,000/mm3 D: hematocrit 38%, hemoglobin 13 g/dL
A: rubella titer, 1:6 A rubella titer of less than 1:8 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period because administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months. The lab values for WBCs, platelets, and hematocrit and hemoglobin are within the expected range for pregnant women.
The nurse is planning care for a patient in her first trimester of pregnancy. The patient is experiencing nausea and vomiting. Which interventions should the nurse plan to share with this patient? (Select all that apply.) A: suck on hard candy B: take prenatal vitamins in the morning C: try some herbal tea to relieve the nausea D: drink fluids frequently but separate from meals E: eat crackers or dry cereal before arising in the morning
A: suck on hard candy D: drink fluids frequently but separate from meals E: eat crackers or dry cereal before arising in the morning A patient experiencing nausea and vomiting should be taught to suck on hard candy, drink fluids frequently but separately from meals, and eat crackers, dry toast, or dry cereal before arising in the morning. Prenatal vitamins should be taken at bedtime because they may increase nausea if taken in the morning. Before taking herbal tea, the patient should check with her health care provider.
A pregnant patient reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this patient receive? (Select all that apply.) A: tetanus B: varicella C: influenza D: hepatitis A and B E: measles, mumps, rubella (MMR)
A: tetanus C: influenza D: hepatitis A and B Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer to women who have a risk for contracting or developing the disease. Immunizations with live virus vaccines such as, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.
The prenatal nurse educator is teaching couples the technique of applying sacral pressure during labor. Which should be included in the teaching session? (Select all that apply.) A: the technique can be combined with heat to the area B: a jiggling motion should be used while applying the pressure C: tennis balls may be used to apply the pressure to the sacral area D: the pressure against the sacrum should be intermittent during the contraction E: the hand may be moved slowly or remain positioned directly over the sacrum
A: the technique can be combined with heat to the area C: tennis balls may be used to apply the pressure to the sacral area E: the hand may be moved slowly or remain positioned directly over the sacrum Sacral pressure can be combined with thermal stimulation to increase effectiveness. The hand may be moved slowly over the area or remain positioned directly over the sacrum, but pressure should be continuous and firm throughout the contraction. Care should be taken not to jiggle the woman, which may be irritating.
Which of the following statements about childbirth preparation classes is not true? Are primarily to provide coping mechanisms for the physical demands of childbirth. Are for medicated and unmedicated birth experiences. Are for new parents and for those who already have children. Are available through the health-care provider and can be located through the Internet.
Are primarily to provide coping mechanisms for the physical demands of childbirth.
The best time to discuss healthy BMI levels and proper nutrition for a healthy pregnancy is __________. At the first prenatal visit. At a preconception visit. Throughout the pregnancy once the first trimester is over and nausea has resolved. Discussion of BMI should be avoided to not offend the patient.
At a preconception visit.
Rachel is a 22-year-old college student who was recently engaged. During her annual gynecological checkup, she mentions that she and her fiancé plan on waiting several years before starting a family. When should preconception counseling be done with Rachel? Select all that apply. After she is married and ready to conceive. At this visit. At every gynecological visit. Previously, at her first gynecological visit. Preconception discussions should take place with her obstetrician of choice once she's married.
At this visit. At every gynecological visit. Previously, at her first gynecological visit.
A nurse is teaching a nonsmoking pregnant patient about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Call the doctor right away for dark, tarry stools. B. Drink at least one glass of orange juice a day. C. Stop the prenatal vitamins while taking iron. D. Take the medication between meals and with milk.
B. Drink at least one glass of orange juice a day.
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? Provide the rubella vaccine as ordered by the physician immediately. Inform the woman she should receive the vaccine in the hospital after delivery. Hold all immunizations until 1 month postpartum. 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.
The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? Blood pressure goes up toward the end of pregnancy. My breathing will get deeper and a little faster. Ill notice a decreased pigmentation in my skin. 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.
The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks gestation. When will the nurse schedule the next prenatal visit? A: 1 week B: 2 weeks C: 3 weeks D: 4 weeks
B: 2 weeks From 29-36 weeks, routine prenatal assessment is every 2 weeks. If the pregnancy is high risk, the patient will see the health care provider more frequently.
Use Nägele's rule to determine the EDD (estimated day of delivery) for a patient whose last menstrual period start on April 12. A: February 19 B: January 19 C: January 21 D: February 7
B: January 19 Nägele's rule subtracts 3 months from the month of the last menstrual period (month 4 - 3 = January) and adds 7 days to the day that the last menstrual period started (April 12 + 7 days = April 19), so the correct answer is January 19 of the following calendar year.
A patient who comes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition? A: congenital anomalies B: death before or after birth C: neonatal hypoglycemia D: neonatal withdrawal syndrome
B: death before or after birth Smoking during pregnancy increases the risk for spontaneous abortion, low birth weight, abruptio placentae, placenta previa, preterm birth, perinatal mortality, and SIDS. Smoking does not appear to cause congenital anomalies, hypoglycemia, or withdrawal syndrome.
Which type of cutaneous stimulation involves massage of the abdomen? A: imagery B: effleurage C: mental stimulation D: thermal stimulation
B: effleurage Effleurage is massage usually performed on the abdomen during contractions. Imagery exercises enhance relaxation by teaching the woman to imagine herself in a relaxing setting. Mental stimulation is a group of methods to decrease pain by increasing mental stimulation. Thermal stimulation decreases pain by using applications of heat and cold.
You are performing assessments for an obstetric patient who is 5 months pregnant with her third child. Which finding would cause you to suspect that the patient was at risk? A: patient states that she doesn't feel any Braxton Hicks contractions like she had in prior pregnancies B: fundal height is below the umbilicus C: cervical changes, such as Goodell's sign and Chadwick's sign, are present D: she has increased vaginal secretions
B: fundal height is below the umbilicus Based on gestational age (20 weeks), the fundal height should be at the umbilicus. This finding is abnormal and warrants further investigation about potential risk. With subsequent pregnancies, multiparas may not perceive Braxton Hicks contractions as being evident compared with their initial pregnancy. Cervical changes such as Goodell's and Chadwick'ssigns should be present and are considered a normal finding. Increased vaginal secretions are normal during pregnancy as a result of increased vascularity.
Which advice to the patient is one of the most effective methods for preventing venous stasis? A: sit with the legs crossed B: rest often with the feet elevated C: sleep with the foot of the bed elevated D: wear elastic stockings in the afternoon
B: rest often with the feet elevated Elevating the feet and legs improves venous return and prevents venous stasis. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Elastic stockings should be applied before lowering the legs in the morning.
You're presenting a prenatal nutrition class to a group of newly pregnancy women. One of your recommendations to insure adequate iron intake would be which of the following? Be sure to drink milk with your iron supplement to help it absorb better. Drinking orange juice with your eggs will help your iron supplement to absorb. Be sure to take your iron supplement with your morning tomato or orange juice to help with absorption. Drinking coffee or tea when you eat breakfast will help your iron supplement to absorb better.
Be sure to take your iron supplement with your morning tomato or orange juice to help with absorption.
A patient whose blood type is A- needs to be educated on the RhoGAM injection at her 16-week prenatal visit. What information would the nurse give at this time? Because your blood type is A-, you'll need to receive a RhoGAM injection at 28 weeks and again within 72 hours after delivery if the infant is Rh-positive. Because your blood type is A-, you will not need the RhoGAM injection. Because you're A-, you will be more likely to develop anemia and need an iron supplement when you get your RhoGAM injection. Because you're A-, you'll need a RhoGAM injection now, at 28 weeks, and at delivery.
Because your blood type is A-, you'll need to receive a RhoGAM injection at 28 weeks and again within 72 hours after delivery if the infant is Rh-positive.
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? 4 weeks 12 weeks 18 weeks 24 weeks
C. 18 weeks There are also fetal stethoscopes specialized to pick up on the fetal heartbeat. - Can't be used until Week 17-19.
A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman? Exercise elevates the mothers temperature and improves fetal circulation. Exercise increases catecholamines, which can prevent preterm labor. A regular schedule of moderate exercise during pregnancy is beneficial. 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.
The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurses initial action? Assess food intake. Weigh the patient again. Take the blood pressure. 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.
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? Fried fish Olive oil Red meat 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.
The health care provider reports that the primigravida's fundus can be palpated at the umbilicus. Which priority questions will the nurse include in the patient's assessment? A: "have you noticed that it is easier for you to breath now" B: "would you like to hear the baby's heartbeat for the first time" C: "have you felt a fluttering sensation in your lower pelvic area yet" D: "have you recently developed any unusual cravings, such as for chalk or dirt"
C: "have you felt a fluttering sensation in your lower pelvic area yet" Quickening is the first maternal sensation of fetal movement and is often described as a fluttering sensation. Quickening is detected at approximately 20 weeks in the primigravida and as early as 16 weeks in the multigravida. The fundus is at the umbilicus at 20 weeks' gestation. Lightening is associated with descent of the fetal head into the maternal pelvis and is associated with improved lung expansion. Lightening occurs approximately 2 weeks before birth in the primipara. Fetal heart tones can be detected by Doppler as early as 9 to 12 weeks of gestation. Pica is the craving for nonnutritive substances such as chalk, dirt, clay, or sand. It can develop at any time during pregnancy. It can be associated with malnutrition and the health care provider should monitor the patient's hematocrit and hemoglobin, zinc, and iron levels.
What is the gravid and para for a patient who delivered triplets 2 years ago and is now pregnant again? A: 2,3 B: 1,2 C: 2,1 D: 1,3
C: 2,1 She has had two pregnancies (gravida 2); para refers to the outcome of the pregnancy rather than the number of infants from that pregnancy. She is pregnant now, so that would make her a gravida 2. She is para 1 because she had one pregnancy that progressed to the age of viability.
A woman reports that her last normal menstrual period began on August 5, 2013. What is this woman's expected delivery date using Nagele's rule? a. April 30, 2014 b. May 5, 2014 c. May 12, 2014 d. May 26,2014
C: May 12, 2014 Seven days are added to the LMP, 3 months subtracted, and where necessary a year added.
Which information is covered by early pregnancy classes offered in the first and second trimesters? A: methods of pain relief B: the phases and stages of labor C: coping with common discomforts of pregnancy D: rebirth and post birth care of a patient having a cesarean birth
C: coping with common discomforts of pregnancy Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. Methods of pain relief are discussed in a childbirth preparation class. The phases and stages of labor are usually covered in a childbirth preparation class. Cesarean birth preparation classes discuss prebirth and postbirth of a patient having a cesarean birth.
A patient, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her funds is palpated 3 cm below the umbilicus. This finding is: A: appropriate for gestational age B: a sign of impending complications C: lower than normal for gestational age D: higher than normal for gestational age
C: lower than normal for gestational age By 20 weeks, the fundus should reach the umbilicus. The fundus should be at the umbilicus at 20 weeks, so 3 cm below the umbilicus is an inappropriate height and needs further assessment. This is lower than expected at this date. It may be a complication, but it may also be because of incorrect dating of the pregnancy.
A gravida 1 patient at 32 weeks of gestation requires that she has severe lower back pain. What should the nurse's assessment include? A: palpation of the lumbar spine B: exercise pattern and duration C: observation of posture and body mechanics D: ability to sleep for at least 6 hours uninterrupted
C: observation of posture and body mechanics Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in pregnancy. Certain exercises can help relieve back pain. Rest is important for overall well-being; however, the primary concern related to back pain is a thorough evaluation of posture and body mechanics.
A patient with an IUD in place has a positive pregnancy test. When planning care, the nurse will base decisions on which anticipated action? A: a therapeutic abortion will need to be scheduled since fetal damage is inevitable B: hormonal analysis will be done to determine the underlying cause of the false-positive test result C: the IUD will need to be removed to avoid complications such as miscarriage or infection D: the IUD will need to remain in place to avoid injuring the fetus
C: the IUD will need to be removed to avoid complications such as miscarriage or infection Pregnancy with an IUD in place is unusual; however, it can occur and cause complications such as spontaneous abortion and infection. A therapeutic abortion is not indicated unless infection occurs.
Susan is 40 weeks 3 days pregnant and has come to OB triage for an assessment of labor. On the monitor, FHR is 145 with moderate variability, and contractions are every 2 to 3 minutes lasting 60 to 90 seconds. Her abdomen palpates as mild to moderate during contractions. Her cervix is 2 cm dilated, 50% effaced, and the fetus is at -2 station. Which part of this assessment is not an expected finding for this stage of labor? FHR 145 with moderate variability. Contractions every 2 to 3 minutes lasting 60 to 90 seconds. 2 cm dilated, 50% effaced, -2 station. Abdomen palpates as mild to moderate during contractions.
Contractions every 2 to 3 minutes lasting 60 to 90 seconds.
At what age is a woman who becomes pregnant for the first time described as an elderly primip? After 25 years old After 28 years old After 30 years old 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.
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? Endovaginal ultrasound Pap test Complete blood count 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.
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? Ask if the patient has taken a sedative. Notify the physician. Turn the patient to her right side 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.
A patient in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse provide regarding safe travel during pregnancy? A: "only travel by car during pregnancy" B: "avoid use of the seat belt during the third trimester" C: "yip can travel by plane until your 38th week of gestation" D: "if you are traveling by car stop to walk every 1-2 hours"
D: "if you are traveling by car stop to walk every 1-2 hours" Car travel is safe during normal pregnancies. Suggest that the woman stop to walk every 1 to 2 hours so she can empty her bladder. Walking also helps decrease the risk of thrombosis that is elevated during pregnancy. Seat belts should be worn throughout the pregnancy. Instruct the woman to fasten the seat belt snugly, with the lap belt under her abdomen and across her thighs and the shoulder belt in a diagonal position across her chest and above the bulge of her uterus. Travel by plane is generally safe up to 36 weeks if there are no complications of the pregnancy, so only traveling by car is an inaccurate statement.
Which is the method of childbirth that helps prevent the fear-tension-pain-cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor? A: Bradley B: Lamaze C: Leboyer D: Dick-Read
D: Dick-Read The Dick-Read method helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor. The Lamaze method involves concentration and conditioning to help the woman respond to contractions with relaxation to decrease pain. Viewing childbirth as a traumatic experience, the Leboyer method uses decreased light and noise to help the newborn adapt to extrauterine life more easily. The Bradley method teaches women to use abdominal muscles to increase relaxation and breath control; it emphasizes avoidance of all medications and interventions.
Determine the obstetric history of a patient in her fifth pregnancy who had two spontaneous abortions in the first trimester, one infant at 32 weeks' gestation, and one infant at 38 weeks' gestation. A: G5 T1 P2 A2 L 2 B: G5 T1 P1 A1 L2 C: G5 T0 P2 A2 L2 D: G5 T1 P1 A2 L2
D: G5 T1 P1 A2 L2 This patient is in her fifth pregnancy, which is G5, she had one viable term infant (between 38 and 42 weeks' gestation), which is T1, she had one viable preterm infant (between 20 and 37 weeks' gestation), which is P1, two spontaneous abortions (before 20 weeks' gestation), which is A2, and she has two living children, which is L2.
A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is: A: using increased environmental stimulation as a method of distraction B: restricting family and friends from visiting during the labor period to keep the patient focused on breathing techniques C: medicating the patient frequently to reduce pain perception D: assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern
D: assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction pattern Relaxation techniques are aimed at incorporating mind and body activities to maintain control over pain. Additional environmental stimuli may have the opposite effect and increase patient anxiety, which will affect pain perception. Restricting visitors may have the opposite effect, leading to increased anxiety because of isolation. Medicating a patient may not decrease pain perception but may place the patient at risk for adverse reactions and/or complications of pregnancy related to medications.
When documenting a patient encounter, which term will the nurse use to describe the woman who is in the 28th week of her first pregnancy? A: multigravida B: multipara C: nullipara D: primigravida
D: primigravida A primigravida is a woman pregnant for the first time. A multigravida has been pregnant more than once. A nullipara is a woman who has never been pregnant or has not completed a pregnancy of 20 weeks or more primipara has delivered one pregnancy of at least 20 weeks. A multipara has delivered two or more pregnancies of at least 20 weeks.
Which of the patient health behaviors in the first trimester would the nurse identify as a risk factor in pregnancy? A: sexual intercourse 2-3 times weekly B: moderate exercise for 30 minutes daily C: working 40 hours a week as a secretary in a travel agency D: relaxing in a hot tub for 30 minutes a day, several days a week
D: relaxing in a hot tub for 30 minutes a day, several days a week Pregnant women should avoid activities that might cause hyperthermia. Maternal hyperthermia, particularly during the first trimester, may be associated with fetal anomalies. She should not be in a hot tub for more than 10 minutes at less than 100F. Sexual intercourse is generally safe for the healthy pregnant woman; moderate exercise during pregnancy can strengthen muscles, reduce backache and stress, and provide a feeling of well-being; working during pregnancy is acceptable as long as the woman is not continually on her feet or exposed to environmental toxins and industrial hazards.
Which technique would provide the best pain relief for a pregnant woman with an occiput posterior position? A: neuromuscular disassociation B: effleurage C: psychoprophylaxis D: sacral pressure
D: sacral pressure The use of sacral pressure may provide relief for patients who are experiencing back labor. The presentation of the fetus in a posterior position indicates this. Neuromuscular dissociation is used as a conditioned response to affect pain relief based on the mother tensing one group of muscles and focusing on releasing tension in the rest of her body. Effleurage is the process of using circular massage to effect pain relief. Psychoprophylaxis is another name for the Lamaze method of prepared childbirth.
What is the rationale for a woman in her first trimester of pregnancy to expect to visit her health care provider every 4 weeks? A: problems can be eliminated B: she develops trust in the health care team C: her questions about labor can be answered D: the conditions of the expectant mother and fetus can be monitored
D: the conditions of the expectant mother and fetus can be monitored This routine allows for monitoring maternal health and fetal growth and ensures that problems will be identified early. All problems cannot be eliminated because of prenatal visits; however, they can be identified early. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy.
Which suggestion is most helpful for the pregnant patient who is experiencing heartburn? A: drink plenty of fluids at bedtime B: eat only three meals a day so the stomach is empty between meals C: drink coffee or orange juice immediately on arising in the morning D: use Tums or Rolaids to obtain relief, as directed by the health care provider.
D: use Tums or Rolaids to obtain relief, as directed by the health care provider Antacids high in calcium (e.g., Tums, Rolaids) can provide temporary relief. Fluids overstretch the stomach and may precipitate reflux when lying down. Instruct the patient to eat five or six small meals per day rather than three full meals. Coffee and orange juice stimulate acid formation in the stomach and may need to be eliminated from the diet.
The goal for prenatal care include all of the following except which answer below? Screening for risk factors. Discussions on appropriate weight gain and nutrition. Determining the gender of the infant. Controlling chronic diseases.
Determining the gender of the infant.
Which of the following statements about electronic fetal monitoring (EFM) is not true? EFM has reduced the cesarean rate in healthy pregnancies since its introduction. EFM can indicate the beginning of the second stage of labor. EFM can indicate fetal sleep/wake cycles. EFM can indicate a tight nuchal cord (cord wrapped around the fetal neck).
EFM has reduced the cesarean rate in healthy pregnancies since its introduction.
When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during pregnancy, the woman responds, I don't like milk. What dietary adjustments could the nurse recommend? Increase intake of organ meats. Eat more green leafy vegetables. Choose more fresh fruits, particularly citrus fruits. Include molasses and whole-grain breads in the diet.
Eat more green leafy vegetables.
Which of the following foods should be avoided during pregnancy? Select all that apply. Eggs sunny-side up Fresh milk from the cow Medium-rare hamburgers on the grill Baked macaroni and cheese A salad with salami and provolone from the deli
Eggs sunny-side up Fresh milk from the cow Medium-rare hamburgers on the grill A salad with salami and provolone from the deli
A woman calls her health care provider to schedule prenatal visits in an uncomplicated pregnancy. How frequently will the nurse assist the patient to schedule these appointments? Every 3 weeks until the 6th month, then every 2 weeks until delivery Every 4 weeks until the 7th month, after which appointments will become more frequent Monthly until the 8th month Every 2 to 3 weeks for the entire pregnancy
Every 4 weeks until the 7th month, after which appointments will become more frequent Normally, patients are seen at a frequency of every 4 weeks until 28 to 32 weeks of pregnancy, then every 2 weeks until 36 weeks, and then weekly until childbirth.
Which of the following statements about labor and delivery are true? Select all that apply. Every labor and delivery is different. Once labor starts, the uterus does not completely relax again until after delivery. If the fetus is not in a favorable position, the provider may attempt to turn them externally. True labor can be defined as cervical change. Spontaneous rupture of membranes (SROM) does not occur until the fetus is about to be delivered.
Every labor and delivery is different. If the fetus is not in a favorable position, the provider may attempt to turn them externally. True labor can be defined as cervical change.
Sally is pregnant and attending her first prenatal visit. During her initial assessment, you ask her about her obstetric history. She tells you she had a miscarriage 6 months ago and has three children at home, one of which was in the NICU for a few weeks because she was delivered at 35 weeks. What is Sally's GTPAL? G5P2113 or G5T2P1A1L3 G5P2213 or G5T2P2A1L3 G4P2113 or G4T3P0A1L3 G4P2113 or G4T2P1A1L3
G5P2113 or G5T2P1A1L3
The nurse explains that the softening of the cervix and vagina is a probably sign of pregnancy. What is the appropriate term for this sign? Chadwick's Hegar's McDonald's Goodell's
Goodell's
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? Gravida 2, para 20120 Gravida 3, para 10011 Gravida 3, para 10110 Gravida 2, para 11110
Gravida 3, para 10110 - Gravida is the number of pregnancies. - Parity refers to the number of births (over 20 weeks) that occur regardless of the outcome.
A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? Eat three well-balanced meals per day and limit snacks. Drink a full glass of fluid at the beginning of each meal. Have crackers handy at the bedside, and eat a few before getting out of bed. Eat a bland diet and avoid concentrated sweets.
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.
Marna is a term G3P1102 patient who was admitted to labor and delivery in active labor a few hours ago. Her NST in OB triage before admittance showed a FHR of 150 with moderate variability and an occasional early deceleration. Her contractions are lasting 40 to 60 seconds every 2 to 4 minutes. Her membranes ruptured 16 hours ago at home, and she didn't begin to contract until an hour ago. Otherwise, her labor has been uncomplicated. Why is the provider ordering continuous fetal monitoring and not intermittent auscultation for Marna? She has a history of a preterm delivery according to her GTPAL. FHR 150 with moderate variability and an occasional early deceleration. Her membranes ruptured 16 hours ago before the onset of labor. Her contractions are lasting 40 to 60 seconds every 2 to 4 minutes.
Her membranes ruptured 16 hours ago before the onset of labor.
A patient who is an ovolactovegetarian may need extra supplementation of ______ and _______ to meet her pregnancy needs. Which choice is correct? Iron and zinc Vitamin C and B12 Folic acid and vitamin D Vitamin C and vitamin D
Iron and zinc
Sara is a new patient who is having difficulty making food choices. She's allergic to tree nuts, legumes, and eggs. Which of the meals below would be a good, safe choice for her to increase her folic acid intake? Pasta salad with fresh vegetables, avocado, and topped with a citrus dressing. Split pea soup with bacon, onions, and a fresh salad of leafy greens on the side. A bran muffin, a glass of orange juice, and a sliced avocado. Roasted asparagus, Brussel sprouts, and asparagus on an antipasta salad with sliced deli ham, salami, and mozzarella.
Pasta salad with fresh vegetables, avocado, and topped with a citrus dressing.
When educating a patient on exercise during pregnancy, which of the following are important to discuss? Select all that apply. Patients who have not been previously physically active should avoid exercise that is strenuous and increases their risk of falls. Exercise should focus on building stamina and endurance to prepare the patient for the labor and delivery process. Exercise should focus on increasing flexibility and helping with comfort. Patients should not start any new activity once pregnant to avoid fetal loss. Bike riding, elliptical use, swimming, and long walks are good suggestions for moms wanting to get in shape in their third trimester.
Patients who have not been previously physically active should avoid exercise that is strenuous and increases their risk of falls. Exercise should focus on increasing flexibility and helping with comfort.
Rosalia is 16 weeks pregnant and showing signs of anemia. When the provider asks her about her diet, Rosalia states she doesn't understand how she could be anemic, as she's been eating the ashes from the fireplace just like her grandmother told her to keep her blood strong. What is Rosalia experiencing by eating wood ash? Pica Cultural influence Bulimia Anorexia
Pica
Mariah is in active labor and being continuously monitored. FHR is 120 with moderate variability and contractions every 3 to 5 minutes. The nurse also notes decelerations that begin and end with the contractions. What is the appropriate nursing action to address these decelerations? Turn the patient left lateral and apply oxygen via facemask at 10 L/min to improve the variability. Notify the provider the patient has a category III strip and needs an emergency cesarean section. Reassure the patient and her support persons that she and the baby are doing well. Perform full intrauterine resuscitation by turning patient to the side, applying oxygen at 8 to 10 L/min, bolusing 500 mL IV fluid, and stopping any oxytocin infusion.
Reassure the patient and her support persons that she and the baby are doing well.
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.) Wear tight-fitting clothing to promote venous return. Eat a large meal before boarding the flight. Request a seat with greater leg room. Drink at least 4 ounces of water every hour. Get up and walk around the plane frequently.
Request a seat with greater leg room. Drink at least 4 ounces of water every hour. Get up and walk around the plane frequently. 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.
For the best maternal satisfaction and outcome, patients should be encouraged to find a care provider who does which of the following. Shares the same thoughts and feelings on pregnancy and delivery management. Shares the same insights on pregnancy and religious preferences. Shares the same insights on delivery management and childrearing techniques. Shares the same philosophies on alternative medicine and is the same culture.
Shares the same thoughts and feelings on pregnancy and delivery management.
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? Supine hypotension syndrome Gestational diabetes Pregnancy-induced hypertension Malnutrition
Supine hypotension syndrome
Fetal attitude is _________________________. The relationship of fetal body parts to each other. The relationship of the fetal long axis, or spine, to the maternal long axis, or spine. The fetal part that that enters the birth canal first. The level of the presenting part in relation to the maternal pelvis.
The relationship of fetal body parts to each other.
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.) Waddling gait Joint instability Urinary frequency Back pain Aching in cervical spine
Waddling gait Joint instability 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.
Angie and her partner are ready to get pregnant and are at the office for preconception counseling. Angie works in a fast-paced job, has a family history of myocardial infarction, and no other health concerns. Her partner builds boats for a living and has a past history of drug use. Both her and her partner are avid tennis players and consider themselves healthy with very low BMIs. What preconceptual counseling items would you focus on for this couple? Select all that apply. Adequate weight and nutrition. Environmental contaminant exposure Managing their chronic conditions Mental health Lifestyle behaviors
a. adequate weight and nutrition - rationale: because they are avid exercisers and have low BMI, a discussion on adequate weight and nutrition to meet pregnancy needs will be important b. environmental contaminant exposure - rationale: because her partner is a boat builder, they may be exposed to chemicals on the job, creating a possible genetic concern for the fetus d. mental health - rationale: because Angie works in a fast-paced job, she may experience mental health concerns related to stress. she should be encouraged to seek counseling for stress-reducing techniques
During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. How early might fetal heart tones be detected with an electronic Doppler device? 4 weeks 8 weeks 10 weeks 14 weeks
c. 10 weeks The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device.
When performing prenatal testing, the nurse knows if the routine test results show signs of concern for a genetic anomaly, the patient will need to _________________. schedule a pregnancy termination contact the local blood blank to discuss transfusions have further testing with a genetic specialist be seen more frequently during the pregnancy
have further testing with a genetic specialist
A patient who is 38 weeks and 2 days pregnant has arrived in OB triage while you are on shift. You know this patient will have appointments every _____ until delivery with their prenatal care provider. 2 weeks week month 3 weeks
week
