NUR 2420 Maternal Nursing Chapter 12: Nursing Management During Pregnancy

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestion(s) by the nurse is helpful? Select all that apply.

Complete moderate exercise daily. Wear compression stockings.

A client at 10 weeks' gestation is reporting nausea and vomiting throughout the day. What interventions would the nurse recommend to this client? Select all that apply.

Eat small frequent meals. Avoid fried foods. Eat saltine crackers before getting out of bed.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?

vaginal bleeding

The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid?

citrus juice

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological challenges

A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving the unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman associate with true labor? Select all that apply.

pain in back that wraps across the abdomen and increases in frequency and intensity pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina

Why is the first prenatal visit usually the longest prenatal visit?

Baseline data is collected.

To prevent exposure to hepatitis A virus, the nurse teaches the pregnant client to avoid which food?

raw fish

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?

"The gloves they provide irritate my hands, so I don't use them."

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?

24 cm

At which gestational age will the nurse no longer associate fundal height directly with week's gestation?

36 weeks

At the first prenatal visit, the client reports her last menstrual period (LMP) was November 16. The nurse determines the estimated due date to be:

August 23

A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?

Conduct an interview in a private room to obtain her health history.

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:

December 30

A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this?

Delay breakfast until mid-morning.

Which information is most important in order to decrease the risk of complications if the client decides to work until her due date?

Frequent rest periods

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?

G5 T3 P1 A1 L4

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?

Helps the lungs remain expanded after the initiation of breathing

Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client?

Instruct the client to refrain from emptying her bladder.

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?

excessive vomiting

A pregnant client tells the nurse, "My health care provider told me that I have the best type of pelvic shape to deliver my baby vaginally." The nurse interprets this statement as indicating that the client has which pelvic shape?

gynecoid

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?

"I'll switch to chewing gum instead of using mints."

A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about:

18 to 20 weeks' pregnant.

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:

4 weeks.

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?

Always wear a three-point seat belt.

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?

Fats are essential during pregnancy, and vegetable oils are a good source.

A woman reports that her last menstrual period (LMP) occurred February 1, 2017. Using the Naegele rule, what would be her estimated date of delivery (EDD)?

November 8, 2017

The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria does the nurse look for on the tracing to determine that the NST is reactive?

Presence of 2 accelerations in 20 minutes

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?

at the level of the umbilicus

A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?

dark, leafy green vegetables

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including:

decreased birth weight in neonates.

Which finding is most worrisome in a client in her 26th week of pregnancy?

facial edema

A woman comes to the clinic for an exam and says that she is considering trying to become pregnant in the next few months. What would the nurse encourage the client to begin taking now?

folic acid

The nurse has just received the results of a pregnant client's MSAFP screening and notes the levels are elevated. The nurse should prioritize which discussion with the client?

further testing is required

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?

maternal serum alpha-fetoprotein analysis

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?

soft systolic murmur

A pregnant client and family are planning a trip that requires a 7-hour car ride. Which education will the nurse provide about traveling in a car?

stopping at least every 2 hours to walk around

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:

the first day of the last menstrual period.

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy?

"Babies of women who smoke tend to weigh significantly less than other infants."

When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used?

anterior surface of the sacral prominence and the anterior surface of the symphysis pubis

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.

4, 1, 1, 1, 1

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor?

contractions beginning in the back and sweeping forward across the abdomen

The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age?

20 weeks

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling

A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?

Sleep on your side.

A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?

April 27

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications.

A nurse is teaching a group of primigravida women who are in their first trimester. One of the women asks the nurse about sexual activity during pregnancy. Which information would the nurse most likely incorporate into the response?

Because of pelvic congestion, women may experience increased clitoral sensitivity.

A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise?

Come to the hospital now for assessment.

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client?

Continue this as long as she enjoys it.

The nurse is preparing a care plan for a primigravida client and her partner who are excited about her pregnancy and ask lots of questions on various subjects. Which nursing diagnosis should the nurse prioritize for this client and her partner in this care plan?

Deficient knowledge

A pregnant client at 9 weeks' gestation is experiencing nausea and vomiting. The client asks the nurse if smoking marijuana could be used to help with the nausea symptoms. How should the nurse respond?

Discuss the symptoms with the health care provider to determine if a prescription for an antiemetic is needed.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?

Document this and continue to monitor the murmur at future visits.

The health care provider is concerned about a client's fetus having appropriate blood flow through the fetal vessels. Which diagnostic test does the nurse anticipate to confirm a diagnosis?

Doppler study

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply.

Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating.

A client at 27 weeks' gestation still walks daily but reports "terrible" heartburn at night. Which action should the nurse point out will best address this situation?

Elevate the head of the bed.

A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile?

Stop and walk every 2 hours.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:

G = 3, T = 1, P = 0, A = 1, L = 1

The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility?

Hemolytic anemia

A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination?

Instruct the client to empty her bladder.

A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?

July 16

A pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client?

Kegel exercises

The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation?

Multiple fetal pregnancy

The nurse is reviewing an employer's guidelines to support pregnant employees. When reviewing the information, which guideline requires further follow-up and education by the nurse?

Promote overtime shifts to save money for parental leave.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs?

Refrain from crossing legs when sitting for long periods.

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?

Rest on the left side for at least 1 hour in the morning and afternoon.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage?

Stretching and breathing exercises such as yoga

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?

Take antacid 1 hour after the multivitamin.

A client at 29 weeks' gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next?

Tell the client these are normal findings during pregnancy.

During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit?

The client reduces her smoking by 50 percent by the next clinic visit.

The nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results?

The fetal heart rate increases with activity and indicates fetal well-being.

The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care?

Wash the nipples with clean water only.

A woman in her first trimester of pregnancy has noted an increase in a thick, whitish vaginal discharge even though she showers daily. The woman shares this information with the clinic nurse, who provides some client education on the topic of leukorrhea. Which interventions should be addressed in this discussion? Select all that apply.

Wear cotton underwear during the day. A perineal pad to absorb the discharge may help.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?

amniotic fluid volume

A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?

at the level of the umbilicus

Which disease process would the nurse screen for under potential genetic disorders?

cystic fibrosis

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy?

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy."

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement?

"I should lie down for 1/2 hour after eating."

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?

"I should substitute intercourse with nonsexual touch to avoid harming the fetus."

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?

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow."

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?

12.0 cm

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?

20 cm

At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1C above which level is concerning for diabetes and warrants further testing?

65%

The nurse is reviewing rubella antibody testing results (above) for a pregnant client at 8 weeks' gestation. What action does the nurse anticipate based on these results?

Administer the measles-mumps-rubella (MMR) vaccine postpartum.

A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of prenatal care? Select all that apply.

Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Identify women at risk for complications.

A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?

Further testing will be required to confirm any diagnosis.

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?

Serve the formula at room temperature.

A pregnant woman reports her last child was born by cesarean birth. She questions if she will be required to have a cesarean birth for this current pregnancy. What information should be provided? Select all that apply.

The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated.

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse?

The steroids speed up the development of the lungs.

The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?

amniocentesis

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location?

at the umbilicus

If a client is receiving total parenteral nutrition (TPN) for hyperemesis gravidarum, which bedside lab tests need to be performed daily? Select all that apply.

blood glucose testing urine for ketones

A pregnant client at 35 weeks' gestation is at a routine prenatal care appointment. Which documented finding (above) is the priority for follow-up by the nurse?

headache treated with ibuprofen

A 38-year-old client and partner are carriers of the Tay-Sachs gene, have one child with Tay-Sachs, and are concerned to learn she is pregnant again. The nurse predicts the health care provider will order which test if the couple wants to know if this baby will also be born with Tay-Sachs?

chorionic villus sampling

When teaching a client about nutrition during pregnancy, the nurse should include which long-term outcomes in the plan of care? Select all that apply.

developing healthy patterns for a lifetime identifying foods to build iron stores incorporating foods to build bone mass designing a diet consistent with cultural factors

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur?

fetal tachycardia

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply.

headache with visual changes in the third trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester

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

The nurse is caring for a client having chorionic villus sampling using the transcervical approach. When preparing the client for the procedure, in which position is the client placed?

lithotomy position

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply.

measles mumps rubella

A nurse is conducting a class with group of pregnant women who are all in their first trimester of pregnancy. During the class, the women are discussing the various discomforts that they are experiencing. The nurse would expect to hear reports about which discomforts? Select all that apply.

nausea urinary frequency breast tenderness

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?

potential for greater than usual back pain

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?

pressure on intestine by the growing fetus

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus?

rubella

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?

rubella

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?

ultrasound equipment