Module 2 PrepU ?s
The nurse is determining a pregnant client's estimated date of delivery (EDD) using Naegele rule. The date of the first day of the client's last normal menstrual period (LNMP) was April 20. What would be this client's EDD? January 20 January 27 December 27 December 25
January 27
A nurse is educating a pregnant client on what food to eat and what to avoid during the pregnancy. Which precaution will the nurse provide regarding the nutritional requirements? Avoid starchy food. Limit the B vitamins. Limit caffeine intake. Avoid fat intake.
Limit caffeine intake.
A pregnant client is planning travel to a foreign country as part of a work assignment and needs immunizations. What should the nurse instruct the client about immunizations while pregnant? The only immunization that should be avoided is for the flu. There are no restrictions on immunizations while pregnant. Live virus immunizations are contraindicated while pregnant. Immunizations should be restricted to live viruses only.
Live virus immunizations are contraindicated while pregnant.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? Maintain tolerable intensity of exercise. Wear support hose when exercising. Reduce the amount of exercise. Begin a new exercise regimen.
Maintain tolerable intensity of exercise.
A client reports that her last menstrual period was on August 1. Using Naegele rule, what would the nurse anticipate as the client's due date? May 24 September 15 May 8 June 6
May 8
The school nurse is presenting a lecture to adolescents to teach them how conception occurs. Which statement by the nurse would accurately describe this process? "The ovum carries the Y chromosome, and the sperm carries an X or Y chromosome." "At the time of conception, the ovum determines the sex of the baby." "Conception usually occurs when the ovum is in the outer third of the fallopian tube." "Human life begins with the union of two cells: the zygote and the sperm."
"Conception usually occurs when the ovum is in the outer third of the fallopian tube."
A pregnant client in the first trimester asks the nurse about taking medications while she is pregnant. She tells the nurse that she heard that it can be harmful to the fetus if medications are taken at certain times during pregnancy. What is the best response by the nurse? "Exposure to certain substances during the embryonic phase may be harmful to the developing fetus." "You cannot drink alcohol, but you can take some medications, such as cold preparations and over-the-counter medications." "There is no need for you to worry; you are not far enough along in your pregnancy for this to be a problem." "As long as you are past 4 weeks of pregnancy, you should be able to take most medications."
"Exposure to certain substances during the embryonic phase may be harmful to the developing fetus."
A pregnant client in her first trimester is being seen at the women's clinic. What statement by the nurse would be most beneficial to this client to support her acceptance of the pregnancy? "I know you are so excited about this baby. Have you begun to think of names?" "I understand that this pregnancy was not planned but I am sure you are very excited anyhow!" "Often women feel angry when they find out that they are pregnant. Did you feel that way?" "Having feelings of uncertainty are very common when a woman becomes pregnant. I will be glad to talk to you about any concerns you may have."
"Having feelings of uncertainty are very common when a woman becomes pregnant. I will be glad to talk to you about any concerns you may have."
The nurse is caring for a client following the birth of the newborn with several birth defects. The client states, "I know the baby has defects because of something I did wrong during my pregnancy. I feel like a horrible mom." How will the nurse respond? "I hear you saying this is a difficult situation. Tell me more about how you are feeling" "I understand...I have a daughter with medical defects due to the medication I took while pregnant." "You should not blame yourself...these things happen for a reason and at least you have other children." "That is one reason we always ask pregnant women to tell us all the medication they take."
"I hear you saying this is a difficult situation. Tell me more about how you are feeling"
After teaching a group of expectant mothers about how to best protect the fetus while in utero, which statement by a mother would best validate understanding of the teaching session? "I don't think 2 to 3 Tylenol each day will harm my baby since it is not a harmful drug." "By drinking my culture's herbal tea each day, I will help my baby grow stronger." "I will not take any medicines that the doctor has not prescribed without checking first." "My mother told me that I need to get my rubella shot soon to help protect the baby from the disease."
"I will not take any medicines that the doctor has not prescribed without checking first."
A pregnant woman enjoys exercising at a local health spa once a week. Which comment would lead the nurse to believe she needs additional health teaching? "Nothing feels nicer than a hot sauna after exercise." "I limit exercising to low-impact aerobics." "The gym gets hot and stuffy by midmorning." "I'm learning to play table tennis."
"Nothing feels nicer than a hot sauna after exercise."
A pregnant client is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse teach the client about fetal respiration? "You are breathing for the baby." "Oxygen is provided to the baby through the placenta." "The baby's lungs can accommodate all of the fluid." "The baby's breathing is very minor until delivery."
"Oxygen is provided to the baby through the placenta."
The nurse teaches the importance of avoiding nonessential substances to a young adult female who is 6 weeks' pregnant. Which client statement indicates that teaching has been effective? "Only one beer or one glass of wine is permitted while pregnant." "Smoking is permitted as long as I do it outdoors." "I can drink on weekends only." "Smoking is bad for me and my baby."
"Smoking is bad for me and my baby."
A pregnant woman asks the nurse about medications taken during pregnancy and if they cross the placental barrier. What response by the nurse is appropriate? "Yes, all medications cross the placental barrier." "Medications taken orally typically do not cross the placental barrier because of the gastric absorption." "Medications taken during the first trimester are typically safe." "Some medications cross the placental barrier, so be sure to discuss medications with your provider."
"Some medications cross the placental barrier, so be sure to discuss medications with your provider."
A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? "You only have a few more weeks until the birth and then you will breathe fine again." "The enlarging uterus pushes against your diaphragm and this makes breathing shallow." "Don't worry about this because it is a normal change that occurs with pregnancy." "Oxygen requirements are increasing in your body because the fetus is growing."
"The enlarging uterus pushes against your diaphragm and this makes breathing shallow."
A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? "As long as you do not increase the amount of alcohol you are drinking there is little risk." "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." "The best thing for you to do is to reduce the amount of alcohol you are drinking."
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."
During a prenatal visit, a pregnant woman says, "I know the amniotic fluid is important, but can you tell me more about it?" When describing amniotic fluid to a pregnant woman, which description would the nurse most likely include? "This fluid acts as transport mechanism for oxygen and nutrients." "This fluid acts as a cushion to help to protect your baby from injury." "The fluid is mostly protein to provide nourishment to your baby." "The amount of fluid remains fairly constant throughout the pregnancy."
"This fluid acts as a cushion to help to protect your baby from injury."
At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse? "No, this is part of the routine prenatal lab work. The test for gestational diabetes will be done during your third trimester." "Yes. If the results of your blood work are elevated you have gestational diabetes and will be started on insulin." "This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." "This is a diagnostic test to identify insulin resistance during pregnancy."
"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."
During a physical assessment, the nurse palpates a pregnant client's fundus at the level of the umbilicus. What statement should the nurse make to the client about this assessment finding? "You are at 12 weeks of your pregnancy." "You are at 36 weeks of your pregnancy." "You can go into labor at any time now." "You are at 20 weeks of your pregnancy."
"You are at 20 weeks of your pregnancy."
A nurse is providing prenatal education about how to avoide microorganisms during pregnancy. Which instruction will the nurse provide? "You should avoid unpasteurized dairy products and undercooked meats." "You should avoid contact with larger sized dogs." "If you have no chronic conditions, you should receive prophylactic antibiotics to prevent infection during the first trimester." "If you are up to date on all your vaccinations, you should be protected from most perinatal infections."
"You should avoid unpasteurized dairy products and undercooked meats."
A client who is 2 months pregnant tells the nurse, "I find that I'm always going to the bathroom to urinate." Which responds by the nurse would be appropriate? "Your baby is making urine so this is adding to what's in your bladder." "Your growing uterus is putting pressure on your bladder causing you to go." "Your kidneys now have less cells to filter the fluid that goes through." "Your urine is more concentrated now, so you have to go more often."
"Your growing uterus is putting pressure on your bladder causing you to go."
A patient is at 22 weeks' gestation is preparing to have her fundal height measured. Given the patient's stage of gestation and following McDonald's rule, what result does the nurse expect? 2.2 cm 11 cm 22 cm 44 cm
22 cm
Implantation generally occurs at which place on the uterus? the lower anterior surface the upper posterior surface directly over the cervical os directly over an opening to a fallopian tube
the upper posterior surface
A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes? 46 23 44 22
46
The nurse is spending time with a client who has just learned, unexpectedly, that she is pregnant. Which initial task should the nurse assist the client to focus on? Sharing time with a significant other Accepting a coming child Accepting the pregnancy Making plans for the baby
Accepting the pregnancy
After a routine examination, a client tells the nurse that she plans to use a home pregnancy test to determine if she is pregnant. What should the nurse's response be to this client's plan? Arrange for prenatal care if the test is positive. Wait until after two missed menstrual periods. Refrain from eating for 4 hours before testing. Use a diluted urine specimen.
Arrange for prenatal care if the test is positive.
A nurse is preparing to perform a physical examination of a pregnant woman at her first prenatal visit. Which of the following actions should the nurse perform before beginning the physical examination? Ask the woman to perform Kegel exercises. Have the woman perform a breast self-examination. Ask the woman to void for a clean-catch urine specimen. Have the woman perform a perineal self-examination.
Ask the woman to void for a clean-catch urine specimen.
Why is the first prenatal visit usually the longest prenatal visit? Laboratory tests are performed. Extensive client teaching is done. A pelvic exam with Papanicolaou test is performed. Baseline data is collected.
Baseline data is collected.
A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do? Sleep on the back with the feet elevated. Lie down immediately after eating. Eat small meals frequently rather than large meals. Consume tomato products and citrus juices regularly.
Eat small meals frequently rather than large meals.
During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom? The cervix has a bluish, purple discoloration. There is a rebound of the fetus felt when the physician pushes on the abdomen. There is hyperpigmentation of the abdomen. The cervix is reddened and swollen.
The cervix has a bluish, purple discoloration.
Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called? Foramen magnum Foramen ovale Foramen venosus Foramen arteriosus
Foramen ovale
A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? From fertilization to the end of the second week after fertilization Approximately 2 weeks after fertilization to the end of the eighth week Approximately 6 weeks after fertilization to the end of 8 weeks Approximately 9 weeks after fertilization to birth
From fertilization to the end of the second week after fertilization
A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion, with four children still living. How would the nurse document this information on the client's chart using the GTPAL system? G4 T3 P1 A1 L5 G5 T1 P1 A3 L5 G5 T3 P1 A1 L5 G5 T3 P1 A1 L4
G5 T3 P1 A1 L4
A pregnant client at 33 weeks' gestation is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she feels lightheaded; her blood pressure is 82/58 mm Hg. What is the most likely explanation for this problem? Her hematocrit is low and she needs additional iron supplements. She did not drink enough fluids prior to coming to the office. She is experiencing supine hypotension syndrome The baby is kicking her spinal column, causing a pinched nerve.
She is experiencing supine hypotension syndrome
The nurse is caring for a client with a G=5, T=0, P=3, A=1, L=3 obstetric history. The nurse is most correct to state which interpretation? The client has had difficulty becoming pregnant. The client has had multiple abortions (elective terminations of pregnancy). The client has had difficulty reaching full term. The client has had uncomplicated pregnancies.
The client has had difficulty reaching full term.
The nurse is planning a class for nurses learning to teach early prenatal classes. Which statement indicates that teaching has been effective? Early prenatal care is needed for a healthy newborn. Early prenatal care is meant to obtain laboratory work and teach the woman regarding danger signs early in the pregnancy. The first prenatal visit should be as soon as the woman misses her period. The goal of early prenatal care is to optimize the health of the woman and the fetus.
The goal of early prenatal care is to optimize the health of the woman and the fetus.
The nursing instructor is illustrating the circulatory flow between the mother and fetus. The instructor determines the session is successful when the class correctly chooses which structure with which route? The two umbilical veins carry waste products from the fetus to the placenta. The one umbilical vein carries oxygen-rich blood to the fetus from the placenta. The one umbilical artery carries oxygen-rich blood to the fetus from the placenta. The two umbilical arteries carry waste products from the placenta to the fetus.
The one umbilical vein carries oxygen-rich blood to the fetus from the placenta.
How does fetal circulation differ from circulation after birth? The umbilical vein carries oxygenated blood, while deoxygenated blood is carried by the umbilical arteries. The ductus arteriosus carries the majority of the blood circulating from the left atrium to the left ventricle directly to the aorta. In utero, blood through the pulmonary artery is only 50% of the post-delivery blood flow. Fetal blood flow bypasses the right atrium and goes directly to the right ventricle.
The umbilical vein carries oxygenated blood, while deoxygenated blood is carried by the umbilical arteries.
The nurse is explaining the process of fertilization to a client who has just learned of being pregnant. On which day during pregnancy should the nurse explain that the embryo implants on the uterine surface? on the fourteenth day of a "typical" menstrual cycle by the fourth day after fertilization by the tenth day after fertilization on the tenth day after the start of the menstrual flow
by the tenth day after fertilization
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first? Listen to fetal heart tones. Take the client's blood pressure. Ask the client to breathe deeply. Turn the client on her left side.
Turn the client on her left side.
A woman of normal weight asks the nurse what an ideal weight gain is during pregnancy. What would be the nurse's best answer? She should not gain over 20 lb. Any gain over 30 lb is ideal. The amount of weight gain is not important. Weight gain of 25-35 lb is ideal.
Weight gain of 25-35 lb is ideal.
You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy? nausea and vomiting a positive pregnancy test fatigue amenorrhea
a positive pregnancy test
The fluid-filled, inner membrane sac surrounding the fetus is which structure? endometrium amnion chorion decidua
amnion
The nurse is assessing several pregnant women in a clinic setting. Which assessment finding would alert the nurse to notify the health care provider? increased skin pigment increased urination and fatigue blood pressure measured at 170/88 mm Hg increased nasal congestion
blood pressure measured at 170/88 mm Hg
If a woman is 3 months pregnant, which of the following findings related to breast changes would you expect to assess? slack, soft breast tissue deeply fissured nipples enlarged lymph nodes darkened breast areolae
darkened breast areolae
On day 3 after a cesarean birth, the client is complaining of soreness in her left leg. On examination the nurse notes the left leg is swollen, and the calf is red, tender and warm to touch. These findings indicate: deep vein thrombosis. varicose veins. venous insufficiency. peripheral artery disease.
deep vein thrombosis.
A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment? experiencing some shortness of breath after walking up five flights of stairs having some discharge from nipples that has never happened before having a hard time having bowel movements and feeling like anal area is swollen feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour
feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour
Depletion of which nutrient during the first trimester makes the fetus susceptible to neural tube defects? folic acid iron potassium thiamine
folic acid
The nursing instructor is teaching a class on the nutritional needs of the pregnant client. The instructor determines the session is successful when the students correctly choose which supplement as being known to prevent up to 70% of CNS birth defects? folic acid iodine vitamin A zinc
folic acid
After teaching a pregnant woman about the hormones produced by the placenta, the nurse determines that the teaching was successful when the woman identifies which hormone produced as being the basis for pregnancy tests? progesterone (progestin) estrogen (estriol) human placental lactogen (hPL) human chorionic gonadotropin (hCG)
human chorionic gonadotropin (hCG)
When caring for a client with lactose intolerance, the nurse would be aware of which potential problem during pregnancy? inadequate folate for neural tube closure inadequate calcium for skeletal growth inadequate protein for muscle development inadequate iron for red blood cell production
inadequate calcium for skeletal growth
Which change in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? increased lordosis joint contraction decreased swayback ligament tightening
increased lordosis
An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question? intimate partner violence mental status social history mood
intimate partner violence
Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which finding? melasma (chloasma) linea nigra vascular spiders striae gravidarum (stretch marks)
linea nigra
A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone? contributes to mammary gland development maintains the endometrial lining of the uterus during pregnancy regulates maternal glucose, protein, and fat levels ensures the corpus luteum of the ovary continues to produce estrogen
maintains the endometrial lining of the uterus during pregnancy
A nurse assesses a primigravida client and observes darkening of the skin on the client's face. How should the nurse document this pigmentation? melasma (chloasma) palmar erythema spider nevi linea nigra
melasma (chloasma)
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 36 weeks, then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth
once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth
A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure? placenta umbilical arteries decidua amniotic fluid
placenta
A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client? engorgement of veins by the weight of the uterus pressure on intestine by the growing fetus relaxation of cardioesophageal sphincter pressure of fetal head on the bladder
pressure on intestine by the growing fetus
A pregnant client in her second trimester visits a health care center. She informs the nurse that at times she experiences difficulty breathing. What would the nurse identify as the most likely cause of the client's report? pressure on the diaphragm by the growing fetus displacement of the stomach by the growing fetus pressure on the rectal vein by the growing fetus pressure on the pelvic area by the growing fetus
pressure on the diaphragm by the growing fetus
A client's menstrual period is two weeks late. She has been feeling tired and has had episodes of nausea in the morning. What classification of pregnancy symptoms is this client experiencing? positive probable no classification presumptive
presumptive
The nurse is teaching a client in the first trimester of pregnancy about the importance of folic acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse teaching the client about this vitamin? sustains a slow and steady weight gain while pregnant controls the risk of hypertension while pregnant maintains energy throughout the pregnancy prevents neural tube disorders in the developing fetus
prevents neural tube disorders in the developing fetus
The nurse is assessing a woman who is pregnant for the first time. Which of the following terms applies to this client? primigravida multipara primipara nulligravida
primigravida
The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? lightening placenta previa quickening linea nigra
quickening
The nurse is providing prenatal education in the community. The nurse advises the pregnant women to check with their health care provider before what activity(ies)? Select all that apply. eating spicy foods receiving immunizations taking "natural" medications taking over-the-counter herbs drinking bottled water
receiving immunizations taking "natural" medications taking over-the-counter herbs
A nurse urges a pregnant client at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention? to avoid anemia to maintain proper blood glucose levels to reduce the risk for hypertension to prevent megalohemoglobinemia
to avoid anemia
A nurse is preparing a client for rhythm strip testing. She places the woman into a semi-Fowler position. What is the appropriate rationale for this measure? to decrease the heart rate of the fetus to prevent supine hypotension syndrome. to aid the woman as she pushes during labor to prevent the woman from falling out of bed
to prevent supine hypotension syndrome.
The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant? positive hCG blood result continued amenorrhea ultrasound picture of her fetus uterine growth
ultrasound picture of her fetus
A nurse is assessing a pregnant client. Which of the following would the nurse document as an abnormal finding in a pregnancy? pedal edema linea nigra visual changes lordosis
visual changes
A fertilized ovum is known as which structure? zygote embryo fetus chorion
zygote