N 158 -- MN Wk 3
The nurse is evaluating the effectiveness of prenatal care and teaching in the 3rd trimester. Select the 4 statements made by the client that indicate that 3rd trimester teaching was effective.
"Now is a good time for my partner & I to take a tour of the birthing unit" "A birth plan will help me communicate my wishes for myself & baby to the HC team" "Now is a good time to take a birthing class" "Once I reach 37 wks of gestation, I will need to be seen weekly in the office" The third trimester is an important time for education. The client must be prepared for what to expect regarding labor and birth and should begin preparing herself and her birth plan. A birth plan can help a patient to communicate needs and wants to the healthcare team. The patient's partner should be included whenever the patient wishes including in all preparation classes such as breastfeeding classes. A partner can help to reinforce learning, will help during labor, and will be there following hospitalization. Both birthing and breastfeeding classes should be offered in the third trimester. The patient should be educated regarding warning signs such as vaginal bleeding and should be instructed to call the doctor and go to the hospital if she thinks she's in labor. She should not be instructed to wait until contractions are very close together to let the doctor know that she is in labor. Beginning at 37 weeks of gestation, it is normal for patients to be seen weekly in the office for a prenatal visit.
The nurse is reviewing prenatal labs and is adding to the anticipated plan of care for the patient each trimester. For each trimester, click to specify the anticipatory guidance HCP orders that would appropriate for the care of the client.
1st trimester -- Ferrous sulfate supplementation 2nd trimester -- Glucose tolerance screen Abd ultrasound for fetal abnorms 3rd trimester -- RhoGAM administration Group beta streptococcus rectovaginal swab The nurse must understand the sequelae of prenatal care and must anticipate individualized care needs based upon information provided by the client. Throughout the pregnancy there are routine screens and assessments considered to be standard of care for all patients. There are also screening evaluations and assessments that need to be performed based upon client needs and individualized risk factors. In the first trimester, a thorough history and physical are collected and conducted. A complete prenatal lab panel includes minimally, a type and screen, complete blood count, hepatitis b surface antigen screening, other virology including HIV screening and/or other hepatitis screening, testing for certain sexually transmitted infections including syphilis, gonorrhea, chlamydia, and trichomoniasis, certain genetic screening (for example, cystic fibrosis carrier screening), and certain titers which may include rubella and varicella. Providers may choose to include other screens and tests in the first trimester based upon patient risk factors and patient preference. A first trimester ultrasound may be performed to confirm patient due date, determine the number of fetuses, and assess fetal cardiac activity but would not be performed solely to determine fetal gender. Vaccine boosters, with the exception of the influenza vaccine depending on the season, are generally not administered in the first trimester of pregnancy. Electronic fetal monitoring is not initiated by most providers until the fetus is considered viable during the second trimester. Upon review of the patient's lab results, the nurse would anticipate that this patient's individualized orders might include ferrous sulfate supplementation as she is anemic with a low hemoglobin and hematocrit. Routine screening during the second trimester includes an ultrasound to check for fetal anomalies and defects, a glucose tolerance screen, and Doppler fetal heart tone monitoring. Pelvic exams are not routinely performed by providers until the last month of pregna
Which presumptive sign of pregnancy will the nurse expect to find when assessing a client at 10 weeks gestation? SATA
Amenorrhea Nausea Breast changes Urinary frequency The key to answering this question is understanding the difference between presumptive versus probable signs of pregnancy. Presumptive signs of pregnancy are less specific subjective changes that are reported by the client during an assessment interview. The absence of menstruation (amenorrhea) is a presumptive sign of pregnancy that is recognized at 4 weeks' gestation. Breast changes, related to increased levels of estrogen and progesterone, are a presumptive sign of pregnancy that is recognized at 3 to 4 weeks' gestation. Urinary frequency, related to pressure of the enlarging uterus on the urinary bladder, is a presumptive sign of pregnancy that is recognized at 6 to 12 weeks' gestation. Nausea is a subjective presumptive sign that presents between 4-14 weeks' gestation. Probable signs of pregnancy are more objective changes that can be measured in the reproductive organs during a physical assessment. Hegar's sign is indicated by a softening of the cervix, which appears bluish and engorged. Chadwick's sign is a bluish discoloration of the cervix, vagina, and labia, an early indicator of pregnancy denoting increased blood flow to the reproductive organs. Abdominal enlargement related to the enlarging uterus is a probable sign of pregnancy that is recognized when the enlarging uterus rises out of the pelvis at 14 to 16 weeks' gestation. Headaches are not a symptom associated with pregnancy and are not considered a presumptive or probable sign.
Which recommendation would the nurse make for a pregnant client experiencing nausea and vomiting? Select all that apply. One, some, or all responses may be correct.
Avoid empty or excessively full stomach Drink real ginger ale or tea, or use real ginger in other recipes Try sucking on sour candies or smelling a citrus scented food or product Eat crackers or vanilla wafers or drink a small amount of liquid before getting OOB Eat carb rich, low fat meals throughout the day, such as toast, oatmeal, or noodle soup Locate the pressure point to reduce nausea in the middle of the wrist and press firmly for 3 min Maintain a good posture Avoiding complete emptying of the stomach or overfilling the stomach can help reduce bouts of nausea. The oft-repeated home remedy ginger for nausea is based on fact and worth a try. Sucking on sour candy or even smelling something sour, such as citrus scented hand lotion might help relieve nausea. Eating a small, bland carb before getting up in the morning cuts back on morning sickness. Small carb-rich, low fat meals spead throughout the day would help the mom avoid an empty stomach, which can cause nausea. There are pressure spots on the wrists that might help relieve nausea; acupuncture from trained eastern medicine specialists might be a consideration. Maintenance of a good posture gives the stomach ample room to function effectively. The client should eat 5-6 small meals a day instead of three good sized meals.
The nurse is reviewing the information from Hx & physical performed today on a new client to the OB-gynecology (GYN) office. Highlight cues that would required action from the nurse at this initial OB visit.
Client drinks alcohol socially (1-2 drinks per week) A Hx of depression BMI: 30 kg/m2 The initial obstetrical visit is a very important part of prenatal care. Healthcare providers collect large amounts of patient history, identify patient-specific risk factors, create a plan for care throughout the pregnancy, and provide education for the newly pregnant patient during this visit. It is essential that the RN can identify areas that require further education or attention based upon information that the patient provides. This client has a history of depression and is taking an SSRI (sertraline). While these medications are considered generally safe in pregnancy, the nurse needs to be able to educate the patient on the medication and the provider should have a discussion of the risks and benefits of continuing the medication throughout the pregnancy. A history of depression also increases a patient's risks for postpartum depression and should be followed throughout the pregnancy. The patient should be assessed for increasing signs of depression at each OB visit. While it is very beneficial for most clients to attend therapy, it does not require attention from the nurse. If she weren't receiving therapy services, a referral may be necessary. Since this is a planned pregnancy, no action is needed regarding her stopping contraceptives. She should not continue these during pregnancy. A discussion of termination options is not warranted at this time. The client should be advised to abstain from all alcohol throughout the entire pregnancy as no amount is safe to use in pregnancy. A gravid abdomen is an expected finding for a pregnant patient and requires no further action by the nurse. Lastly, this patient's prepregnancy BMI is considered obese which increases risk for this patient and her fetus. Teaching regarding appropriate physical activity, diet, and weight gain should be initiated at this time.
The Pt complains to the nurse of vomiting frequently, "expecially in the morning and with weird smells." The nurse plans to teach the Pt about nausea and vomiting of pregnancy. Select the 5 priority teaching points for a Pt with nausea and vomiting of pregnancy.
Eat a small number of crackers or toast before getting OOB in AM Eat a snack with protein (PB) before bedtime Signs of dehydration include excessive thirst, tachycardia, fever, & [ ] urine Some women find it helpful to experiment with food combos such as sweet and salty or sweet and sour to prevent nausea Ask your HCP before taking herbal remedies or meds for your N/V Many women experience nausea and vomiting of pregnancy, especially in the first trimester. The nurse must plan to educate women with accurate information on ways to manage the signs and symptoms of this condition. Minimizing the signs and symptoms of this condition allow for better rest and nutrition for the gravid mother. Taking prenatal vitamins in the evening, rather than in the morning may help to decrease symptoms for some women. Rising from bed slowly and eating dry foods like crackers and toast also help to relieve some symptoms in the morning. It is recommended that rather than consuming three large meals a day, that the patient consume five to six small meals. Eating a snack with protein, such as peanut butter, before bedtime can be helpful. Fluids should be increased but are generally tolerated better in between meals rather than with them. Foods with offensive odors or that are spicy such as onions, cabbage, curry, or hot sauce are triggers for many and should be avoided. Sucking on hard candy, however, is reported to be helpful for many women that experience nausea and vomiting of pregnancy. Alternating sweet and salty or sweet and sour foods and combinations are also more easily tolerated by many women. It is important that women recognize signs of dehydration such as fever, tachycardia, fatigue and lethargy, excessive thirst, concentrated urine, and dry and cracked lips and mucous membranes. Lastly, as with all medications and herbal remedies, the pregnant patient should ask their healthcare provider prior to initiating treatment.
The nurse is assessing a pregnant 16 yo client. Which factor associated with adolescent pregnancy would the nurse consider when developing a plan of care for this client? SATA
Higher rate of postpartum depression -- Adolescents may be more susceptible to postpartum depression due to hormonal changes, lack of support, and the stress of becoming a parent at a young age. Higher rate of anemia -- Pregnant adolescents are at a higher risk of anemia due to increased iron needs during pregnancy. Inappropriate diet choices Incomplete bone mass Adolescents have higher rates of postpartum depression than older women. An important aspect of nursing care for pregnant adolescents is to engage with them during the pregnancy and provide a supportive, welcoming environment and to develop a network of community resources supportive of pregnant and parenting teens to address their psychosocial issues. Adolescents may have inadequate diets and eat more fast foods. The diet is generally high in fats and carbohydrates and deficient in protein, calcium, fruits, and vegetables. Anemia is more common in teens and intensive nutrition evaluation and counseling is indicated. Peak bone mass is reached in the late teens or early 20s. When a teen is pregnant, higher levels of calcium are required to both provide support for the pregnancy and to support the teen's own bone health. An increased risk of gestational diabetes, mortality, and infantile chromosomal abnormalities are associated with the client of advanced maternal age over 35-years-old. Secondary sex characteristics appear early and are complete by the end of puberty; if the adolescent is pregnant, she has completed puberty.
A client with a large fetus is to have a pudendal block during the second stage of labor. What does the nurse plan to instruct the client about the effectiveness of the block? SATA
Perineal pain will not be felt The bearing down reflex will be diminished Ctx-related pain continues The pudendal block provides anesthesia to the perineal area, after which pain is not felt in the lower vagina, vulva, or perineum. Although the bearing-down reflex is diminished, muscle control is not affected, and the client is able to bear down with contractions. The block does not eliminate uterine pain caused by contractions. Contractions are not decreased by either rate or intensity as a result of the block. The block affects only the perineum, not the bladder. It does not influence the decision of whether an episiotomy is needed. Fetal heart rate and maternal hemodynamics are not affected by a pudendal block.
. The client is 27 wks pregnant and has called the telephone triage nurse to review the results of her 1 hr glucose tolerance screen. Choose the most likely options for the info missing from the statements.
The nurse correctly interprets the glucose level (92) as higher than expected. The nurse informs the Pt that she will need a 3 hr glucose tolerance test dx gestational diabetes. A 1-hour glucose screen level greater than 140 mg/dL is considered abnormal and high. When a 1-hour glucose tolerance test is high, a 3-hour glucose tolerance test should be performed to confirm the diagnosis of gestational diabetes. A diagnosis is not made from a 1-hour glucose screen.
For each topic taught click to specify the response by the patient that would indicate adequate understanding of the topic.
Vaccinations during pregnancy -- "it's considered safe for most pregnant women to receive inactivated influenza immunization" "It's recommended that I receive the Tdap vaccine with each pregnancy" "Live attenuated vaccines are not recommended during pregnancy" Safety in pregnancy -- "I should continue to eat plenty of fresh fruits, lean meats, grains, & vegetables during my pregnancy" "I should maintain good vaginal hygiene and avoid douching" Common discomforts of pregnancy -- "Leg cramps can be a normal part of pregnancy for some" "I can increase my fluid and fiber intake in order to help with constipation" Vaccinations are an important part of pregnancy, but it is important that the pregnant patient not receive live vaccines as they are known to have teratogenic effects on the fetus. An influenza vaccine is recommended with each pregnancy during flu season as well as the Tdap vaccine between 27 and 36 weeks of gestation. The MMR vaccine is not recommended in pregnancy as it is a live virus vaccine. During pregnancy, deli meats should be avoided as they can transmit potentially harmful bacteria between the mother and fetus if they are contaminated. No amount of alcohol is safe in pregnancy. However, hygiene and nutrition are important, and the woman should eat a healthy, balanced diet. She should shower and complete vaginal hygiene frequently. However, douching is not considered a safe form of vaginal hygiene. Aches and pains are common in pregnancy and safe options for medications are available. However, aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) are potentially harmful to the fetus and should be avoided in pregnancy. Hot tub time should be limited to 10 minutes or less as overheating may be harmful to the fetus. Some women may experience venous congestion in pregnancy and leg cramps for which dorsiflexion may help. Constipation is also common in pregnancy and can be eased at times using increased fluids and increased dietary fiber intake.
Which medication would the nurse question if prescribed for a pregnant client? Select all that apply. One, some, or all responses may be correct.
Warfarin Phenytoin Isotretinoin Clavulanate Methotrexate Some medications are not safe to take during pregnancy because of the adverse effects to the fetus and/or newborn. Warfarin, phenytoin, isotretinoin, clavulanate, and methotrexate are not safe during pregnancy. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for pregnant clients with depression because they have few side effects and are relatively safe. Common SSRIs used for the treatment of depression during pregnancy include citalopram, fluoxetine, and sertraline.
