Maternity & Women's Healthcare- Chapter 14: Nursing Care of the Family During Pregnancy

The nurse is performing a physical assessment of a pregnant patient. What precaution will the nurse take to prevent supine hypotension in the patient? 1 Place a small wedge under the patient's right hip. 2 Give a back massage to the patient before assessment. 3 Instruct the patient to empty her bladder before assessment. 4 Instruct the patient to drink warm milk before assessment.

1 An abdominal examination is part of a physical assessment. For abdominal examination, the patient lies on her back, and the weight of her abdominal contents compresses the vena cava and aorta, which results in supine hypotension. Therefore, during a physical assessment the nurse should place a small wedge under the patient's right hip to prevent supine hypotension. A back massage is helpful for promoting sleep, not for preventing supine hypotension. The nurse should instruct the patient to empty her bladder for fundal assessment, but emptying the bladder does not prevent supine hypotension. Intake of warm milk promotes sleep, but it does not prevent supine hypotension during a physical assessment.

The nurse is assessing a patient who weighs 57 kg in the first month of pregnancy. The nurse plans a diet regimen to provide adequate nutrition to the patient. Which assessment finding at the end of the third month would indicate that the diet prescribed was effective? The patient: 1 Weighs 59 kg. 2 Weighs 62 kg. 3 Has good-quality sleep. 4 Has regular bowel movements.

1 A pregnant patient usually has nausea and vomiting during the first trimester. The nurse should ensure proper nutrition by prescribing an appropriate diet plan. Ideally, the patient should gain 2 kg body weight by the end of the first trimester. Thus the patient should weigh 59 kg (57 + 2) by the end of her first trimester. Excess weight gain (62 kg) is not a good sign in pregnancy and could lead to complications such as gestational hypertension and gestational diabetes. Sleep disturbances and constipation are commonly observed in the second trimester of pregnancy. These problems are not associated with maternal weight gain or impaired nutrition.

The nurse is assessing the transvaginal ultrasound report of a pregnant patient. After assessment, the nurse instructs the patient to avoid air travel. What is the reason for giving this instruction? To prevent: 1 Preterm labor in the client 2 Supine hypotension 3 Peripartum hemorrhage 4 Gestational hypertension

1 Transvaginal ultrasound is performed to determine the cervical length of a pregnant patient. When the cervical length is found to be short, the patient is at risk for preterm labor, and patients at risk for preterm labor are advised to avoid air travel. To prevent supine hypotension, the pregnant patient should be instructed on maintaining side-lying or semisitting postures. Avoiding air travel does not prevent supine hypotension. Peripartum hemorrhage occurs during delivery and cannot be prevented by avoiding air travel. Gestational hypertension is a pregnancy complication that is not affected by air travel.

Which signs and symptoms in a pregnant patient would the nurse attribute to elevated levels of estrogen? Select all that apply. 1 Angiomas 2 Gingivitis 3 Constipation 4 Nose bleeding 5 Gastrocnemius spasm

1, 2, 4 Angiomas, gingivitis, and nose bleeding occur in the pregnant patient because of an increase in estrogen levels. Angiomas (spider nevi) appear on the neck, thorax, face, and arms during the second or third trimester of pregnancy. Estrogen increases vascularity and proliferation of the connective tissue. This results in gingivitis. Estrogen causes hyperemia of the mucous membranes. This results in nose bleeding. Constipation during pregnancy results from an increase in progesterone (not estrogen) levels. Gastrocnemius spasm during pregnancy is caused by a reduced level of diffusible serum calcium or an elevation of serum phosphorus.

After assessing a pregnant patient, the nurse finds that the patient has carpal tunnel syndrome. Which symptoms helped the nurse to arrive at this conclusion? Select all that apply. 1 Tingling 2 Numbness 3 Increased sweating 4 Dropping of objects 5 Flatulence and bloating

1, 2, 4 Carpal tunnel syndrome results from compression of the median nerve caused by changes in the surrounding tissues. Tingling, numbness, and dropping of objects are symptoms of carpal tunnel syndrome. It causes pain and loss of skilled movements. During pregnancy, the sweat glands are more active, and this results in increased sweating. Flatulence with bloating occurs during pregnancy because of reduced gastrointestinal motility caused by hormonal changes.

The nurse is assessing a patient with couvade syndrome. What symptoms is the nurse likely to find? Select all that apply. 1 Nausea 2 Skin rashes 3 Sore throat 4 Weight gain 5 Persistent cough

1, 4 Couvade syndrome is a condition in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. During this condition some emotional and physiologic changes are observed in the men. Couvade syndrome does not have any impact on the skin or throat. Therefore the patient will not have skin rashes, sore throat, or persistent cough.

All pregnant women should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause. a.Severe vomiting in early pregnancy b.Epigastric pain in late pregnancy c.Severe backache and flank pain d.Decreased fetal movement e.Glycosuria 1. Fetal jeopardy or intrauterine fetal death 2. Kidney infection or stones 3. Gestational diabetes 4. Hyperemesis gravidarum 5. Hypertension, preeclampsia

1. ANS: D 2. ANS: C 3. ANS: E 4. ANS: A 5. ANS: B

The nurse instructs a pregnant patient to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease? 1 Constipation 2 Varicose veins 3 Supine hypotension 4 Urinary tract infections

2 Varicose veins are observed in pregnant patients usually in the second or third trimesters. Prolonged sitting increases the blood pressure in the legs veins, causing varicose veins. Patients who spend more time sitting (e.g., at a desk job) have a high risk for developing varicose veins. Similarly, wearing tight-fitting pants can also affect the venous return and cause stasis of the blood in the veins. Constipation is another regularly observed complication during pregnancy. Increased intake of fiber and water is helpful to relieve constipation. Supine hypotension is caused when the abdominal contents compress the inferior vena cava in the supine position. This can be relieved by changing the positions when sleeping. Urinary tract infections can be prevented during pregnancy by increasing the intake of water and by emptying bladder regularly.

During the first trimester, the pregnant woman is most motivated to learn about: 1 fetal development. 2 impact of a new baby on family members. 3 measures to reduce nausea and fatigue so she can feel better. 4 location of childbirth preparation and breastfeeding classes.

3 During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family is an appropriate topic for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester, a woman works on the task of, "I am going to have a baby." Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

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?" The nurse's best response is: 1 "This is normal behavior and should begin to subside by the second trimester." 2 "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." 3 "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." 4 "You seem impatient with her. Perhaps this is precipitating her behavior."

3 Emotional lability, rapid and unpredictable changes in mood, is related to hormone changes and anxiety during pregnancy. Stating that the woman's behavior is normal is correct but does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This statement is judgmental and not appropriate.

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: 1 Down syndrome. 2 sickle cell anemia. 3 cardiac defects. 4 open neural tube defects such as spina bifida

4 A triple marker test determines the levels of MSAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects. Low levels of MSAFP are associated with Down syndrome. Sickle cell anemia is not detected by the MSAFP. Cardiac defects are not detected with the MSAFP.

The nurse is explaining to a pregnant patient about prevention of motor vehicle accidents. What risk is most associated with motor vehicle accidents in pregnant patients? 1 Preterm birth 2 Thrombophlebitis 3 Ectopic pregnancy 4 Abruptio placentae

4 Every pregnant patient should be taught about safety measures to prevent motor vehicle accidents. Automobile accidents may lead to placental separation, causing fetal death. This condition is called abruptio placentae. Preterm birth and ectopic pregnancy are not associated with automobile accidents. Thrombophlebitis is commonly observed in pregnant patients because the heavy abdominal contents compress the blood vessels. Pregnant patients are usually taught certain exercises to prevent thrombophlebitis.

On assessing a pregnant patient, the nurse finds that the patient's fundal height is 27 cm at 28 weeks' gestation. What does the nurse conclude from this finding? This measurement indicates: 1 Polyhydramnios. 2 Multifetal gestation. 3 Ectopic pregnancy. 4 Normal development.

4 From the assessment, the nurse concludes that development of the fetus is normal at 28 weeks' gestation. According to the standard measurement, fundal height (in centimeters) is approximately equal to the number of weeks of gestation. The patient's bladder should be empty while the nurse measures the fundal height. An excessive increase in fundal height indicates polyhydramnios or multifetal gestation. Vaginal bleeding and abdominal cramping during the first trimester of pregnancy indicate the possibility of an ectopic pregnancy.

A pregnant patient with a urinary tract infection is being discharged from the hospital after recovery. What preventive measures does the nurse suggest to the patient? Select all that apply. A "Drink cranberry juice." B "Drink acidophilus milk." C "Regularly take bubble baths." D "Drink 2 liters of fluids daily." E "Use scented toilet paper.

ANS A, B, D The nurse should instruct the patient to drink cranberry juice and acidophilus milk, because they have antibacterial properties and help prevent recurrence of urinary tract infections. The nurse should advise the patient to drink at least 2 liters of fluids per day to maintain adequate hydration. This also promotes optimal urination and prevents bacterial infection. The nurse should instruct the patient to avoid bubble baths because they can irritate the urethra. The nurse should instruct the patient to avoid using scented toilet paper because it may irritate the genitourinary tissues.

A pregnant patient works as a supervisor in a manufacturing unit. The nurse advises the patient not to stand for prolonged periods, despite the demands of her occupation. Why should the pregnant patient not stand for prolonged periods? To lower the risk for: A Leg cramps B Preterm labor C Thrombophlebitis in the legs D Carpal tunnel syndrome

ANS B The client works in a manufacturing unit and needs to stand for prolonged periods. During pregnancy, the patient should neither stand nor sit for prolonged periods because doing so may adversely affect fetal health. Therefore the nurse instructs the patient to not stand for a prolonged period so as to reduce the risk for preterm labor. Leg cramps result from reduced levels of diffusible serum calcium or an elevation in serum phosphorus levels. Thrombophlebitis can result from sitting with crossed legs for prolonged periods. Carpal tunnel syndrome results from compression of the median nerve that results from the changes in the surrounding tissues; it is not caused by prolonged standing or sitting.

A patient who is 6 months pregnant asks about the proper placement of her seatbelt. Teaching by the nurse has been successful if the patient makes which statement? a I need to position the lap belt loosely directly over my belly button." b "I need to place the lap belt portion snugly over the upper part of my uterus." c "I need to place the seatbelt directly over the widest part of my abdomen." d "I need to place the lap belt portion low across my hip bones as snugly as is comfortable.

ANS D Rationale: The lap belt/shoulder harness combination should be used as well as the headrest. Correct placement of the lap belt portion is placed low across the hip bones and should be as snug as comfortable. Placing the seatbelt directly over the widest part of the abdomen is not warranted because this can cause the seatbelt not to function correctly. Placement of a seatbelt, independent of pregnancy, should always be secured as the manufacturer suggests. The pregnant or nonpregnant woman holds the seatbelt at the insertion point and then extends it diagonally to reach across the upper torso and abdomen, securing it to the fastener on the opposite side. The correct application involves making sure that the seatbelt was fastened securely. Positioning the lap belt loosely over the bellybutton does not indicate the correct placement

A pregnant patient reports severe leg cramps, especially in the reclining posture. The nurse assesses the patient's laboratory reports. Which factor is responsible for the leg cramps in the patient? A Elevated estrogen level B Elevated progesterone level C Elevated serum calcium level D Elevated serum phosphorus level

ANS D Elevated serum phosphorus levels cause leg cramps in pregnant patients. During pregnancy, hormonal changes occur in the body. Elevated estrogen levels cause nasal stuffiness, epistaxis, angiomas, and gingivitis. Elevated progesterone levels cause constipation. Leg cramps (gastrocnemius spasm) are caused when serum calcium levels are low.

As relates to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: a. the father goes through three phases of acceptance of his own. b. the father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. c. in the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. typically men remain ambivalent about fatherhood right up to the birth of their child.

ANS: A A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that: a. both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. c. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

ANS: A Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of after birth care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. all women, regardless of risk factors. b. a woman who has had more than one sexual partner. c. a woman who has had a sexually transmitted infection. d. a woman who is monogamous with her partner.

ANS: A Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test is recommended for all women, regardless of risk factors. Women who test positive for HIV can be treated, reducing the risk of transmission to the fetus. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? a. She keeps all prenatal appointments. b. She "eats for two." c. She drives her car slowly. d. She wears only low-heeled shoes.

ANS: A The goal of prenatal care is to foster a safe birth for the infant and mother. Although eating properly, driving carefully, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that: a. tub bathing is permitted even in late pregnancy unless membranes have ruptured. b. the perineum should be wiped from back to front. c. bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d. expectant mothers should use specially treated soap to cleanse the nipples.

ANS: A The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

The multiple marker test is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing, such as ultrasonography and amniocentesis, would be required to diagnose these conditions.

Signs and symptoms that a woman should report immediately to her health care provider include: (Select all that apply.) a. vaginal bleeding. b. rupture of membranes. c. heartburn accompanied by severe headache. d. decreased libido. e. Urinary frequency.

ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Patients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate healthcare interventions.

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? (Select all that apply.) a. Tetanus b. Diphtheria c. Chickenpox d. Rubella e. Hepatitis B

ANS: A, B, E Vaccines consisting of killed viruses may be used. Immunization with live or attenuated live viruses is contraindicated during pregnancy because of potential teratogenicity. Immunizations that may be administered during pregnancy include *tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines.* Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

The nurse working with pregnant clients must seek to gain an understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate? a.Nonacceptance of the pregnancy very often equates to a rejection of the child. b.Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. c.Ambivalent feelings during pregnancy are usually only expressed in emotionally immature or very young mothers. d.Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will naturally resolve themselves after birth.

ANS: B Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women and for younger or older women. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise? a.To check the sensitivity of the nipples b.To determine whether the nipple is everted or inverted c.To calculate the adipose buildup in the abdomen d.To see whether the fetus has become inactive

ANS: B Sometimes known as the pinch test, this exercise is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples, nor is it not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

A woman's last menstrual period was June 10. Her estimated date of delivery (EDD) is a.April 7 b.March 17 c.March 27 d.April 17

ANS: B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17).

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion b. Modesty c. Ignorance d. Belief that physicians are evil

ANS: B A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be: a. constipation. b. alteration in the pattern of fetal movement. c. heart palpitations. d. edema in the ankles and feet at the end of the day.

ANS: B An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize? a. How the baby will "get out"? b. What the baby will eat? c. Whether her mother will die? d. What color eyes the baby has?

ANS: B By age 3 or 4, children like to be told the story of their own beginning and accept its comparison with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. School-age children take a more clinical interest in their mother's pregnancy and may want to know, "How did the baby get in there?" and "How will it get out?" Whether her mother will die does not tend to be the focus of a child's questions about the impending birth of a sibling. The baby's eye color does not tend to be the focus of children's questions about the impending birth of a sibling.

During the first trimester, a woman can expect which of the following changes in her sexual desire? a. An increase, because of enlarging breasts b. A decrease, because of nausea and fatigue c. No change d. An increase, because of increased levels of female hormones

ANS: B Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender; this tends to interfere with coitus, decreasing the desire to engage in sexual activity.

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: a. do Kegel exercises. b. do pelvic rock exercises. c. use a softer mattress. d. stay in bed for 24 hours.

ANS: B Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin: a. before the first missed menstrual period. b. after the first missed menstrual period. c. after the second missed menstrual period. d. after the third missed menstrual period.

ANS: B Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant mother and her infant.

A nurse should advise which women about continued condom use during pregnancy? a. Unmarried pregnant women b. Women at risk for acquiring or transmitting sexually transmitted infections (STIs) c. All pregnant women d. Women at risk for candidiasis

ANS: B The objective of "safer sex" is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and her fetus, condom use is recommended throughout pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice "safer sex" behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. All pregnant women are encouraged to practice "safer sex" behaviors. The client should be educated as to what may place both herself and the fetus at risk. Any pregnant woman might develop candidiasis. This is not related to condom use.

Which statement about multifetal pregnancy is inaccurate? a. The expectant mother often develops anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins often are more pronounced.

ANS: B Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

The number of routine laboratory tests during follow-up visits is limited; however, those that are performed are essential. Which statements regarding group B Streptococcus (GBS) testing are correct? (Select all that apply.) a.Performed between 32 and 34 weeks of gestation. b.Performed between 35 and 37 weeks of gestation. c.All women should be tested. d.Only women planning a vaginal birth should be tested. e.Women with a history of GBS should be retested.

ANS: B, D, E GBS testing is recommended between 35 and 37 weeks of gestation; cultures collected earlier will not accurately predict the presence of GBS at birth. All women should be tested, even those planning an elective cesarean birth. Membranes may rupture early, requiring prophylactic antibiotics. Clients with a history of GBS should be retested.

With regard to the initial visit with a patient who is beginning prenatal care, nurses should be aware that: a. the first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions. b. if nurses observe handicapping conditions, they should be sensitive and not enquire about them because the patient will do that in her own time. c. nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support. d. because of legal complications, nurses should not ask about illegal drug use; that is left to physicians.

ANS: C Besides these potential problems, nurses need to be alert to the woman's attitude toward health care. The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. Nurses must be sensitive to special problems, but they do need to inquire because discovering individual needs is important. People with chronic or handicapping conditions forget to mention them because they have adapted to them. Getting information on drug use is important and can be done confidentially. Actual testing for drug use requires the patient's consent.

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit, blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to twelve women are placed in gestational-age cohort groups. d. Outcomes are similar to those of traditional prenatal care.

ANS: C Gestational-age cohorts comprise the groups with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early after birth visit. Before group sessions the patient has an individual assessment, physical examination, and history. At the beginning of each group meeting, patients measure their own blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a study of adolescent patients, there was a decrease in low-birth-weight infants and an increase in breastfeeding rates.

With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that: a. because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child. b. nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. c. women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. d. the woman's sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

ANS: C Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings. The second trimester is the time when a woman's sense of well-being, along with certain physical changes, increases her desire for sex. Desire is decreased in the first and third trimesters.

The nurse should be aware that the partner's main role in pregnancy is to: a. provide financial support. b. protect the pregnant woman from "old wives' tales." c. support and nurture the pregnant woman. d. make sure the pregnant woman keeps prenatal appointments.

ANS: C The partner's main role in pregnancy is to nurture the pregnant woman and to respond her feelings of vulnerability. In older societies, the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers' participation in the birth experience over the past 30 years.

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: a. the interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. during the abdominal examination, the nurse should be alert for supine hypotension. d. for pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

ANS: C The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women hypertension is defined as a systolic BP of 140 or greater and a diastolic BP of 90 or greater.

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 you need to modify your exercise to walking later in your pregnancy, around the seventh month." d. "Jogging is too hard on your joints; switch to walking now."

ANS: C 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.

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform? a.Assess the fetal heart tones with a Doppler stethoscope. b.Measure the girth of the woman's abdomen. c.Complete an ultrasound examination (sonogram). d.Offer the woman and her family the opportunity to listen to the fetal heart tones.

ANS: D To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their baby's heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit.

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: a. mother of the pregnant woman. b. couple's teenage daughter. c. sister of the pregnant woman. d. expectant father.

ANS: D An expectant father's experiencing pregnancy-like symptoms is called the couvade syndrome.

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Blood pressure is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that: a. women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. while working or traveling in a car or on a plane, women should arrange to walk around at least every 2 hours or so.

ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

Which symptom is considered a warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. Vaginal bleeding

ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester complaints. Although they may be worrisome or annoying to the mother, they usually are not indications of pregnancy problems.

In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a. To promote family unity b. To ward off the "evil eye" c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy

ANS: D The purpose of all cultural practices is to protect the mother and fetus during pregnancy. Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: a. "Since you're in your second trimester, there's no problem with having one drink with dinner." b. "One drink every night is too much. One drink three times a week should be fine." c. "Since you're in your second trimester, you can drink as much as you like." d. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

ANS: D The statement "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy" is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? a. "Don't worry about it; you'll feel better in a month or so." b. "Have you talked to your husband about how you feel?" c. "Perhaps you really don't want to be pregnant." d. "Hormonal changes during pregnancy commonly result in mood swings."

ANS: D The statement "Hormonal changes during pregnancy commonly result in mood swings" is accurate and the most appropriate response by the nurse. The statement "Don't worry about it; you'll feel better in a month or so" dismisses the patient's concerns and is not the most appropriate response. Although women should be encouraged to share their feelings, "Have you talked to your husband about how you feel" is not the most appropriate response and does not provide the patient with a rationale for the psychosocial dynamics of her pregnancy. "Perhaps you really don't want to be pregnant" is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman's responses are normal. She should be reassured about her feelings

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibility. b. Fantasizes about the child's gender and personality—views the child as part of herself—becomes introspective. c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy. d. "I am pregnant."—"I am going to have a baby."—"I am going to be a mother."

ANS: D The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, "I am pregnant," "I am going to have a baby," and "I am going to be a mother" sum up the progression through the three phases.

The nurse is reviewing the lab reports of a patient who is 10 weeks pregnant and has a family history of diabetes mellitus. The nurse finds that the patient's 1-hour glucose tolerance test is normal. What does the nurse advise the patient? a. "Increase food intake." b. "Repeat the test at 28 weeks." c. "Undergo a renal function test." d. "Undergo a 3-hour glucose test."

Ans B Rationale: The pregnant patient has a family history of diabetes and may be at high risk for developing gestational diabetes. Because the initial 1-hour glucose tolerance test results are normal, the patient should be advised to repeat the test again at 28 weeks of pregnancy. The patient has normal blood sugar levels and is therefore unlikely to have renal complications. The patient does not need to undergo a renal function test. The laboratory reports do not indicate that the patient has any nutritional deficiencies and does not indicate a need for the patient to increase her food intake. A 3-hour glucose test is conducted only for pregnant patients whose 1-hour glucose tolerance test is positive.

A pregnant patient asks the nurse, "How can I prevent blockage of the nipples while breastfeeding when my baby is born?" What cleaning instructions should the nurse provide to the patient regarding nipple care? a "Use soap." b "Apply tincture." c "Use alcohol." d "Rinse with warm water."

Ans D

During the first trimester of pregnancy, a patient reports abdominal cramps and vaginal bleeding. The nurse learns that the patient is a smoker. What patient clinical condition does the nurse infer from this assessment? A Ectopic pregnancy B Multifetal gestation C Carpal tunnel syndrome D Gestational diabetes mellitus

Ans a Rationale: Maternal smoking increases the chances of ectopic pregnancy during the first trimester. This is characterized by abdominal cramping and vaginal bleeding. Excessive fundal height is a sign of multifetal gestation. Numbness, tingling, burning, loss of skilled movements, and dropping of objects are symptoms of carpal tunnel syndrome. Abdominal cramps and vaginal bleeding do not indicate diabetes mellitus, which is characterized by elevated blood glucose levels.

The nurse is assessing a pregnant patient and finds that the patient has had spinal surgery. What does the nurse interpret from the assessment? A. Epidural anesthesia is contraindicated in the patient. B. Cesarean birth should be recommended for the patient. C. The patient may have higher chances of preterm delivery. D. The patient may have right lower quadrant pain during pregnancy

Ans. A Rationale: From the assessment, the nurse determines that the patient has a history of spinal surgery, and epidural anesthesia can lead to severe complications in such patients. A history of spinal surgery does not cause preterm delivery or cesarean birth. If the patient has had uterine surgery or extensive repair of the pelvic floor, then cesarean birth would be recommended. Unlike appendicitis, spinal surgery does not cause right lower quadrant pain during pregnancy.

Kegel's exercise is done in pregnancy in order to: A. Strengthen perineal muscles. B. Relieve backache. C. Strengthen abdominal muscles. D. Prevent leg varicosities and edema.

Answer: A. Strengthen perineal muscles Kegel's exercise is done by contracting and relaxing the muscles surrounding the vagina and anus in order to strengthen the perineal muscles.

When assessing a client at 12 weeks of gestation, the nurse recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes? A. At 16 weeks of gestation. B. At 20 weeks of gestation. C. At 24 weeks of gestation. D. At 30 weeks of gestation.

Answer: D. At 30 weeks of gestation. Learning is facilitated by an interested pupil. The couple is most interested in childbirth toward the end of the pregnancy when they are beginning to anticipate the onset of labor and the birth of their child. At 30 weeks, is closest to the time when parents would be ready for such classes.

A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply. A. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. B. The patient can monitor fetal activity once daily for a 60-minute period and note activity. C. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. D. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.

Correct Answer: B, C, & D The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours. Fetal movement is one show of a baby's health in the womb. Each woman should learn the normal pattern and number of movements for her own baby. A change in the normal pattern or number of fetal movements may mean the baby is under stress. And it's not normal for a baby to stop moving with the start of labor.

A woman arrives at the clinic for a pregnancy test. The first day of her LMP was September 10, 2014. Her expected date of birth (EDB) is __________.

June 17, 2015 Using the Nägele's rule, June 17, 2015, is the correct EDB. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of September 10, 2014: September 10, 2014 - 3 months = June 10, 2014 + 7 days = June 17, 2014 + 1 year = June 17, 2015.

A nurse examining a prenatal client recognizes that a lag in the progression of measurements of fundal height from month to month and week to week could signal: A. Intrauterine growth restriction. B. Twin pregnancy. C. Polyhydramnios. D. Breech position.

ans A. Rationale: A lag in progression of measurements of fundal height from month to month and week to week could signal intrauterine growth restriction (IUGR).

A pregnant client who is of normal prepregnancy weight is now 30 weeks pregnant. She asks the nurse what appropriate weight gain would be for her. The nurse's best response is: A. "25-35 pounds." B. "30-40 pounds." C. "17-18 pounds." D. "Less than 15 pounds."

ans A. Rationale: Optimum ranges of weight gain are: underweight woman, 28-40 pounds; normal-weight woman, 25-35 pounds; overweight woman, 15-25 pounds; and obese woman, less than 15 pounds.

The nurse should be aware that the pinch test is used to: a. Check the sensitivity of the nipples. b. Determine whether the nipple is everted or inverted. c. Calculate the adipose buildup in the abdomen. d. See whether the fetus has become inactive.

ans: B The pinch test is used to determine whether the nipple iseverted or inverted. Nipples must be everted to allowbreastfeeding.

The nurse is assessing a patient who has an unplanned pregnancy. The patient says to the nurse, "My partner is not happy that I'm pregnant." What should be a relevant response by the nurse? "Your partner should: 1 Be advised to play with children." 2 Be given adequate time to adapt to the idea of having a baby." 3 Be encouraged to develop a new hobby." 4 Visit an orphanage a for few days."

2 During an unplanned pregnancy, some partners find it difficult to accept the impending changes in life plans and lifestyles, but over time they adapt to the reality of pregnancy. Because the patient's partner is not mentally prepared for the baby, it is not advisable to ask the partner to play with children, develop a new hobby, or visit an orphanage.

While assessing a pregnant patient, the nurse finds that the patient has increased flatulence, bloating, and belching. Which intervention should the nurse suggest to reduce this discomfort? 1 "Drink acidophilus milk regularly." 2 "Chew foods slowly and thoroughly." 3 "Increase consumption of fatty food." 4 "Increase fluid intake before bedtime."

2 During pregnancy, gastrointestinal motility is reduced by changes in hormone levels. This increases bacterial action and results in gas production, which results in flatulence, bloating, and belching. Therefore, to improve digestion and prevent gas production, the nurse should advise the patient to chew foods slowly and thoroughly. Drinking acidophilus milk prevents urinary tract infection but does not help reduce flatulence. The patient should avoid consuming fatty food because it increases flatulence and belching. The patient should not increase fluid intake before bedtime because it may cause frequent urination.

During the first trimester of pregnancy, a patient reports nasal stuffiness and nose bleeding. What does the nurse identify as the probable reason? 1 Low iron level 2 High estrogen level 3 High progesterone level 4 Low serum calcium level

2 Estrogen levels increase during pregnancy and result in hyperemia of mucous membranes, which is characterized by nasal stuffiness and nose bleeding. Anemia is caused by low iron levels. High progesterone levels slow gastrointestinal tract motility and digestion, which may cause constipation. Low serum calcium levels cause gastrocnemius spasm.

The nurse is assessing a pregnant patient who complains of painful urination. The patient says, "My urine is dark in color." What will the nurse tell the patient to do? 1 "Take bubble baths regularly." 2 "Increase your fluid intake." 3 "Include dry carbohydrates in your diet." 4 "Get regular back rubs."

2 If a pregnant patient has less than the recommended fluid intake, her urine could be of a dark color. Therefore the nurse should advise the patient to increase her fluid intake to help dilute her urine. Bubble baths are usually not recommended in pregnant women because they may irritate the urethra. The pregnant patient is advised to take dry carbohydrates to prevent vomiting during the first trimester of pregnancy, but a dry carbohydrate diet has no effect on the patient's urination patterns. Regular back rubs can ease back pain in the pregnant patient, but they have no effect in diluting the urine.

The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret from this? The husband has: 1 Vena cava syndrome. 2 Couvade syndrome. 3 Carpal tunnel syndrome. 4 Brachial plexus traction syndrome.

2 Intake of dry carbohydrate is recommended in pregnant patient's diet to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome.

The nurse is assessing a pregnant patient who has undergone bariatric surgery in the past. What will the nurse primarily check in the patient's health records? 1 Family history 2 Nutritional status 3 Blood glucose levels 4 Blood pressure

2 Patients who have undergone bariatric surgery are at a high risk for impaired nutrition, so the nurse should regularly monitor the patient's nutritional status. The client's family history is considered to rule out the risk for congenital anomalies in the fetus, which is not necessary in this case. Blood glucose levels are monitored if the patient is at high risk for developing gestational diabetes during the first or last trimester. Blood pressure levels are usually monitored in the pregnant patient during regular visits to assess the risk for gestational hypertension.

If exhibited by an expectant father, what is a warning sign of *ineffective adaptation* to his partner's first pregnancy? 1 Views pregnancy with pride as a confirmation of his virility 2 Consistently changes the subject when the topic of the fetus/newborn is raised 3 Expresses concern that he might faint at the birth of his baby 4 Experiences nausea and fatigue, along with his partner, during the first trimester

2 Persistent refusal to talk about the fetus may be a sign of a problem and should be assessed. Viewing the pregnancy with pride is normal. Expressing concern about fainting at the birth is normal. Experiencing pregnancy-like symptoms is called couvade syndrome.

As the pregnancy progresses, the patient experiences shortness of breath when the fundal height is being assessed. What action should the nurse take to minimize the shortness of breath or dizziness as a result of the weight of the growing uterus? 1 Use a new paper tape measure for each visit to decrease infection. 2 Place a small towel under the patient's right hip. 3 Place a pillow under the patient's knees whenever she is on her back. 4 Place the patient on her right side while the measurement is done.

2 Placing a small towel under the patient's right hip decreases the direct pressure on the major vessels in the abdomen, which become compressed when the patient lies on her back. Infection control is not an issue at this time. Placing a pillow under her legs may make the patient more comfortable, but won't improve perfusion. Placing the patient on her right side does not allow for proper measurement while maximizing perfusion.

The nurse works in a maternity unit. Which patient condition in her history would be a contraindication for epidural anesthesia during labor? 1 Appendectomy 2 Spinal surgery 3 Uterine surgery 4 Pelvic floor problems

2 The patient with a history of spinal surgery should not undergo epidural anesthesia. The patient with a history of appendectomy, uterine surgery, or pelvic floor problems can undergo epidural anesthesia.

The nurse advises an alcoholic patient to stop consuming alcohol during pregnancy. What could be the reason for this? To prevent: a Angiomas in the fetus b Urinary infections in the patient c Teratogenic effect in the fetus d Gastrocnemius spasm in the patien

ANS C Alcohol has teratogenic effects such as fetal alcohol syndrome. It causes devastating effects and impairs fetal development. Therefore, to prevent these teratogenic effects the nurse should advise the pregnant patient to avoid consuming alcohol. Angiomas (spider nevi) result from an increased concentration of estrogen in the pregnant women. They are not caused by alcohol consumption. Alcohol consumption has no effect on the urinary system. Gastrocnemius spasm results from low levels of diffusible serum calcium or elevation of serum phosphorus.

A pregnant patient complains of constipation. While checking the patient's history, the nurse learns that the patient is taking oral iron supplements. What instruction does the nurse give the patient 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."

ANS C 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 increases reabsorption of water. This in turn leads to the drying of stools, or constipation. Therefore the nurse should instruct the patient to drink six to eight glasses of water every day. During pregnancy, the nurse should not instruct the patient 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 patient to stop taking iron supplementation because iron supplements are essential to prevent anemia.

From the 33rd week of gestation till full term, a healthy mother should have a prenatal check-up every: A. Week B. 2 weeks C. 3 weeks D. 4 weeks

Answer: A. In the 9th month of pregnancy, the mother needs to have a weekly visit to the prenatal clinic to monitor fetal condition and to ensure that she is adequately prepared for the impending labor and delivery.

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest. B. Platelet infusion. C. Immediate cesarean delivery. D. Labor induction with oxytocin.

Answer: A. Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding. Option B: The greatest risk of placenta previa is hemorrhage. Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This may require blood transfusion during Cesarean section.

A pregnant woman's last menstrual period began on April 8, 2020, and ended on April 13. Using Naegele's rule her estimated date of birth would be: A. January 15, 2021 B. January 20, 2021 C. July 1, 2021 D. November 5, 2020

Answer: A. January 15, 2021. Naegele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a Naegele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule was used on April 8, 2020, the estimated date of birth was January 15, 2021.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound

Answer: D. Transvaginal ultrasound An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? Select all that apply. A. Perform ultrasound to determine fetal positioning. B. Observe the patient for possible uterine contractions. C. Administer RhoGAM to the patient if she is Rh-negative. D. Perform a mini catheterization to obtain a urine specimen to assess for bleeding.

Answer: B & C Ultrasound is used prior to the procedure as a visualization aid to assist with the insertion of the transabdominal needle. RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. RhoGAM is administered by intramuscular (IM) injection. RhoGAM is purified from human plasma containing anti-Rh (anti-D). The position of the baby in the uterus is called the presentation of the fetus. Ideally for labor, the baby is positioned head-down, facing the mother's back with the chin tucked to its chest and the back of the head ready to enter the pelvis. This position is called cephalic presentation. Option D: There is no need to assess the urine for bleeding as this is not considered to be a typical presentation or complication.

In the later part of the 3rd trimester, the mother may experience shortness of breath. This complaint may be explained as: A. A normal occurrence in pregnancy because the fetus is using more oxygen. B. The fundus of the uterus is high pushing the diaphragm upwards. C. The woman is having an allergic reaction to the pregnancy and its hormones. D. The woman may be experiencing complications of pregnancy.

Answer: B. From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory diaphragm upwards. Thus, the lungs have reduced space for expansion consequently reducing the oxygen supply.

Which of the following would the nurse most likely expect to find when assessing a pregnant client with an abruption placenta? A. Excessive vaginal bleeding B. Rigid, board-like abdomen C. Tetanic uterine contractions D. Premature rupture of membranes

Answer: B. The most common assessment finding in a client with an abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common. It's possible for the blood to become trapped inside the uterus, so even with a severe placental abruption, there might be no visible bleeding. Uterine contractions are a common finding with placental abruption. Contractions progress as the abruption expands, and uterine hypertonus may be noted. Contractions are painful and palpable. Increased frequency of placental abruption was found in patients with early rupture of membranes. The incidence was 50% and 44% when rupture of the membranes occurred before 20 weeks or between 20-24 weeks of pregnancy, respectively.

A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client's complaint of vaginal bleeding? A. Placenta previa B. Abruptio placentae C. Ectopic pregnancy D. Spontaneous abortion

Answer: B. Abruptio placentae The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae. The hypertension and increased levels of catecholamines caused by cocaine abuse are thought to be responsible for a vasospasm in the uterine blood vessels that causes placental separation and abruption.

You are performing an abdominal exam on a 9th-month pregnant woman. While lying supine, she felt breathless, had pallor, tachycardia, and cold clammy skin. The correct assessment of the woman's condition is that she is: A. Experiencing the beginning of labor. B. Having supine hypotension. C. Having sudden elevation of BP. D. Going into shock.

Answer: B. Having supine hypotension. Supine hypotension is characterized by breathlessness, pallor, tachycardia, and cold, clammy skin. This is due to the compression of the abdominal aorta by the gravid uterus when the woman is in a supine position.

client who is 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client's preparation for parenting, the nurse might ask which question? A. "Are you planning to have epidural anesthesia?" B. "Have you begun prenatal classes?" C. "What changes have you made at home to get ready for the baby?" D. "Can you tell me about the meals you typically eat each day?"

Answer: C. "What changes have you made at home to get ready for the baby?" During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment.

During a prenatal class, the nurse explains the rationale for breathing techniques during preparation for labor based on the understanding that breathing techniques are most important in achieving which of the following? A. Eliminate pain and give expectant parents something to do. B. Reduce the risk of fetal distress by increasing uteroplacental perfusion. C. Facilitate relaxation, possibly reducing the perception of pain. D. Eliminate pain so that less analgesia and anesthesia are needed.

Answer: C. Breathing techniques can raise the pain threshold and reduce the perception of pain. They also promote relaxation.

Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first? A. "Do you have any chronic illness?" B. "Do you have any allergies?" C. "What is your expected due date?" D. "Who will be with you during labor?"

Answer: C. "What is your expected due date?" When obtaining the history of a patient who may be in labor, the nurse's highest priority is to determine her current status, particularly her due date, gravidity, and parity. Gravidity and parity affect the duration of labor and the potential for labor complications. Later, the nurse should ask about chronic illness, allergies, and support persons.

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele's rule, the nurse determines the estimated date of confinement as: A. July 26, 2013 B. June 12, 2014 C. June 26, 2014 D. July 12, 2014

Answer: C. June 26, 2014. Accurate use of Naegele's rule requires that the woman has a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.

If the LMP is Jan. 30, the expected date of delivery (EDD) is: A. Oct. 7 B. Oct. 24 C. Nov. 7 D. Nov. 8

Answer: C. Nov. 7 Based on the last menstrual period, the expected date of delivery is Nov. 7. The formula for Naegele's Rule is to subtract 3 from the month and add 7 to the day.

A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A. Proteinuria, headaches, vaginal bleeding B. Headaches, double vision, vaginal bleeding C. Proteinuria, headaches, double vision D. Proteinuria, double vision, uterine contractions

Answer: C. Proteinuria, headaches, double vision A patient with pregnancy-induced hypertension complains of a headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria.

A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus: A. Weekly fetal movement counts are made by the mother. B. Contraction stress testing is performed weekly. C. Induction of labor begins at 34 weeks' gestation. D. Nonstress testing is performed weekly until 32 weeks' gestation.

Answer: D. Nonstress testing is performed weekly until 32 weeks' gestation For most clients with type 1 diabetes mellitus, non-stress testing is done weekly until 32 weeks' gestation and twice a week to assess fetal well-being

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? A. "I will need to have a full bladder for the test to be done accurately." B. "I should have my husband drive me home after the test because I may be nauseated." C. "This test will help to determine whether the baby has Down syndrome or a neural tube defect." D. "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

Answer: D. The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

During the first prenatal visit, the client denies having had rubella or the rubella vaccine. What would be an appropriate action by the nurse based on this information? A. administer the rubella vaccine B. take a blood sample to assess the rubella titer C. have the client call her mother to ask if the client had German measles as a child D. state that since rubella has little effect on the fetus she shouldn't worry about exposure to the disease

ans B. Rationale: Exposure to rubella (German Measles) is a significant concern because the disease is known to be teratogenic. Mom cannot have the immunization while pregnant, but will need to have the immunization during the immediate postpartum period.

The nurse is planning a childbirth education class for women in their first trimester of pregnancy. Which of the following topics will be most appropriate? A. breathing techniques for pain relief in labor B. choosing a prenatal care provider C. postpartum self-care D. care of the newborn infant

ans B. Rationale: Material presented should be relevant to the needs of the client. Newly pregnant parents need to be encouraged to begin prenatal care early. Breathing techniques will be taught during the 3rd trimester.

A client appears in the clinic for her first prenatal visit at 26 weeks of pregnancy. She states, "I didn't see any point in coming sooner since I felt fine." The nurse makes which statement to explain why prenatal care in the first trimester is important? A. "We want to get to know our patients better. This gives us time to collect an accurate history and plan for potential problems." B. "We need to monitor fetal lung maturity and fetal movement in case you go into labor early." C. "Important cellular growth happens in the first trimester. Early assessment and education promotes a healthy pregnancy during this time." D. "The most important thing is to see if you are even pregnant. Many women mistake a missed period for pregnancy."

ans C. Rationale: The key here is what is most important in early prenatal care ..... assessment and education because if we can have mother live a healthier lifestyle, the healthier the chance of the fetus.

Which of the following would be part of a routine physical assessment for a second-trimester primiparous client whose prenatal care began in the first trimester and is ongoing? A. Measurement of the diagonal conjugate B. Hepatitis B screening (HBsAg) C. Fundal height measurement D. Complete blood count

ans C. Rationale:At each prenatal visit, the blood pressure, pulse, and weight are assessed, and the size of the fundus is measured. Fundal height should be increasing with each prenatal visit.

A pregnant client is to be screened for gestational diabetes with an oral glucose tolerance test (GTT) using a 50-gram glucose load. The nurse explains that the client should schedule the test to be done at point in the pregnancy? A. 12 weeks' gestation B. 16 weeks' gestation C. 24 weeks' gestation D. 36 weeks' gestation

ans C. Rationale: The OGTT screen is done between 24-28 weeks. If they fail the screen, then they will have a 2 or 3 hour OGTT done.

A pregnant patient asks the nurse about a trial of labor after cesarean. What is the patient's reason for asking about this? The patient is: a Having a preterm delivery. b In her late 30s. c Having multiple fetuses. d Attempting a vaginal birth.

ans D Trial of labor after cesarean is the method in which the patient who has had a cesarean delivery previously attempts to have a vaginal delivery in the present pregnancy. The patient who has preterm birth risk would generally undergo a cesarean. Women who get pregnant at an older age are at a high risk for having pregnancy complications. These women usually have cesarean delivery. The patient who has a multifetal pregnancy would generally undergo a cesarean.

A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? A. Point the toes of the affected leg. B. Increase intake of protein-rich foods. C. Limit her activity for several days. D. Flex the foot to stretch the calf.

ans D. Rationale: Dorsiflexing the foot will allow stretching of the calf muscles and will help relieve the cramps.

Which behavioral change does the nurse observe in the spouse/partner of a pregnant patient during the focusing phase? a Engages in building a relationship with the newborn b Has difficulty accepting changes in life plans and lifestyles c Engages in discussions with others about the philosophy of life d Engages in extramarital affairs because of a lack of partner's attention

ans a Rationale: The focusing phase is the third phase of the developmental pattern. It begins in the last trimester. During this phase, the spouse/partner of the pregnant patient prepares for parenthood and tries to build a relationship with the child. During the second phase of pregnancy, the patient's partner engages in discussions about the philosophy of life. This phase is also called the moratorium phase. During the first stage of pregnancy, the patient's partner may engage in extramarital affairs and could face difficulty accepting changes in life plans and lifestyles. This stage is also called the announcement phase

The nurse is assessing the fetal heart rate in a pregnant patient. The nurse findsasynchronous fetal heartbeats during auscultation. In which condition would this finding be considered normal? a Late pregnancy b First pregnancy c Multifetal pregnancy d Surrogate pregnancy

ans c Rationale: 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 patient who has multiple fetuses. Asynchronous fetal heartbeats are abnormal signs during late pregnancy, first pregnancy, and surrogate pregnancy. In these conditions, asynchronous fetal heart beats indicate cardiac dysfunction in the fetus.

After reviewing the obstetric reports of a pregnant patient, the nurse finds that the patient's fundal height has not changed in the last 4 weeks. What condition does the nurse potentially interpret from this finding? a Polyhydramnios b Multifetal gestation c Maternal malnourishment d Intrauterine growth restriction (IUGR)

ans d Stable or decreasing fundal height indicates that fetal growth does not correspond to the mother's gestational age. This indicates intrauterine growth restriction of the fetus. Polyhydramnios is a condition in which the amniotic fluid volume is greater than normal. In this condition, fundal height is greater than normal. Multifetal gestation is the presence of more than one child. Maternal malnourishment may affect the growth of the fetus but is not directly associated with fundal height.

A pregnant woman reports a sudden discharge of fluid from the vagina before 37 weeks' gestation. What does the nurse infer from this observation? This is a sign of: a Renal calculus in the patient. b Intrauterine fetal death. c Gestational diabetes mellitus. d Premature rupture of membrane

ans d Sudden discharge of fluid from the vagina before 37 weeks indicates premature rupture of membranes. Severe backache or flank pain is sign of renal calculus (renal stone). Absence of fetal movements during the third trimester indicates intrauterine fetal death. A positive glucose tolerance test indicates gestational diabetes mellitus.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: a intercourse should be avoided. b intercourse is safe until the third trimester. c safer-sex practices should be used once the membranes rupture. d intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

ans d Uterine contractions that accompany orgasm can stimulate labor and can be problematic if the woman is at risk for or has a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.

A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2010. Her expected date of birth (EDB) would be: a. September 17, 2010. b. November 7, 2010. c. November 21, 2010. d. December 17, 2010.

ans: C Using Nägele's rule, November 21, 2010, is the correct expected date of birth. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010: February 14, 2010 - 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010

For what reason would breastfeeding be contraindicated? a. Hepatitis B b. Everted nipples c. History of breast cancer 3 years ago d. Human immunodeficiency virus (HIV) positive

ans: D* Rationale: Women who are HIV positive are discouraged from breastfeeding. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive women should receive the hepatitis B vaccine and immune globulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer would be a contraindication to breastfeeding

Which statement about pregnancy is accurate?a.A normal pregnancy lasts about 10 lunar months .b.A trimester is one third of a year. c.The prenatal period extends from fertilization to conception. d.The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.

ans: a A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest.

Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension? a. Baseline BP 120/80, current BP 126/85 b. Baseline BP 100/70, current BP 130/85 c. Baseline BP 140/85, current BP 130/80 d. Baseline BP 110/60, current BP 110/60

ans: b An increase in the systolic BP of 30 mm Hg or more over the baseline pressure or an increase in the diastolic BP of 15 mm Hg or more over the baseline pressure is a significant finding, regardless of the absolute values. A current BP of 130/85 indicates that such increases have occurred in both the diastolic and systolic pressures.

With regard to dental care during pregnancy, maternity nurses should be aware that: a. Dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway. b. Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders. c. If dental treatment is necessary, the woman will be most comfortable with it in the second trimester. d. Dental care interferes with the expectant mother's need to practice conscious relaxation.

ans: c The second trimester is best for dental treatment because it is when the woman can sit most comfortably in the dental chair. Dental care such as brushing with fluoride toothpaste is critical during pregnancy because nausea during pregnancy may lead to poor oral hygiene. Emergency dental surgery is permissible, but the mother must clearly understand the risks and benefits. Conscious relaxation is beneficial, and it may even help the woman get through any dental appointments; it is not a reason to avoid them