OB 12
A pregnant patient is experiencing a vaginal discharge and wants to douche. What should the nurse instruct the patient about this health practice? Select one: a. Avoid routine douching. b. Use an alkaline solution. c. Use only a commercial solution. d. Use a solution that has been chilled.
a. Avoid routine douching. Douching while pregnany is contraindicated because of the force of the irrigating fluid could cause the solution to enter the cervix and lead to uterine infection. In addition douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Tha alkalinity, purchase type, or temperature of the solution does not matter. The pregnanct patient should not douche.
The nurse is planning a seminar that focuses on the 2020 National Health Goals during pregnancy for patients who are in the first trimester of pregnancy. Which information should the nurse include in this seminar? (Select all that apply.) Select one or more: a. Stop smoking. b. Increase exercise. c. Eat a healthy diet. d. Reduce work hours. e. Limit alcohol intake.
a. Stop smoking. b. Increase exercise. c. Eat a healthy diet. e. Limit alcohol intake. The 2020 National Health Goals for pregnancy include objective to abstain from social and binge alcohol intake, avoid smoking, receive prenatal care, and abstain from illicit dugs. Seeking alternative care approaches in not a 2020 National Health Goal for pregnancy.
A pregnant patient has a history of genital herpes lesions and has experienced outbreaks periodically throughout the pregnancy. What should the nurse instruct the patient regarding this virus if lesions are present at the time of delivery? A) A cesarean section will be advised at the time of birth. B) There are no precautions needed at the time of birth. C) The patient will need medication immediately after birth. D) The baby will be given a vaccination against the virus at birth.
A) A cesarean section will be advised at the time of birth. If gential lesions are present at the time of birth, as fetus may contract the virus from direct exposure. A woman who has existing genital lesions at the time of birth will be advised to have a cesarean birth to reduce the risk of infecting the baby. There are precautions that need to be undertaken if lesions are present at the time of birth. The use of medication will depend on the patient's and infant's exposure to the virus.
What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol one to two times a week? A) Avoid all alcohol while pregnant. B) Avoid alcohol in the first trimester. C) The effects of alcohol on the fetus are not fully understood. D) An occasional drink is permitted only after the first trimester.
A) Avoid all alcohol while pregnant. There is evidence to confirm that women who consume large quantities of alcohol during pregnancy can have babies with congenital craniofacial deformities. It is impossible to define a safe level of alcohol comsumption. Women should be screened for alcohol use at a first prenatal visit and advised to abstrain from alcohol completely for the remainder of their pregnancy. Refer pregnant women with alcohol treatment program as early in pregnancy as possible to help them reduce their alcohol intake.
A pregnant patient is experiencing leg cramps. What should the nurse include in the patient's teaching plan as a relief measure? (Select all that apply.) A) Avoid full leg extension. B) Elevate lower extremities. C) Elevate the legs on two pillows. D) Stand on each leg and perform a squat. E) Bend the knee and perform dorsiflexion
A) Avoid full leg extension. B) Elevate lower extremities. If a pregnant woman is experiencing frequent leg cramps, she may be advised to elevate lower extremitites frequently during the day to improve circulation and avoiding full leg extension. Elevating the legs on two pillows may or may not help the patient. The patient should not be instructed to perform squats or dorsiflexion to help with the leg cramps.
A patient enjoys exercising and wants to know if it can continue to be done while pregnant. What should the nurse instruct the patient about exercising at this time? (Select all that apply.) A) Drink plenty of liquids to prevent dehydration. B) Limit strenuous exercise to no longer than 20 minutes. C) Eat a low-protein, simple carbohydrate snack before exercising. D) Warm up for 5 minutes by walking or cycling on low resistance. E) Avoid exercises that require jumping or rapid changes in direction.
A) Drink plenty of liquids to prevent dehydration. B) Limit strenuous exercise to no longer than 20 minutes. D) Warm up for 5 minutes by walking or cycling on low resistance. E) Avoid exercises that require jumping or rapid changes in direction. The nurse should instruct the patient to drink liquids to prevent dehydration, limit strenuous exercise to 20 minutes, warm up before beginning an exercise session, and avoid exercises that can jar the body. The patient should be instructed to eat a protein and complex carbohydrate snack before exercise to maintain the serum glucose.
A woman who is 4 months pregnant asks what can be done to alleviate frequent heart palpitations and leg cramps. Which nursing diagnosis would be applicable to the patient at this time? A) Pain related to severe complications of pregnancy B) Health-seeking behaviors related to ways to relieve discomforts of pregnancy C) Risk for ineffective breathing pattern related to pressure of the growing uterus D) Impaired urinary elimination related to inability to excrete creatine from the muscles
B) Health-seeking behaviors related to ways to relieve discomforts of pregnancy The patient is asking for information to reduce the symptoms of heart palpitations and leg cramps are not severe complications of pregnancy. There is no evidence to suggest theat the patient is at risk for an ineffective breathing pattern. There is also no evidence to support the the patient is experiencing impaired urinary elimination.
A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms? A) Exercise helps reduce the frequency of them. B) If rhythmical, they could indicate preterm labor. C) Lying down for a few hours will help them stop. D) They are false labor and do not need to be reported.
B) If rhythmical, they could indicate preterm labor. Beginning as early as the 8th to 12th week of pregnancy, the uterus periodically contracts and then relaxes again. These sensations are Braxton Hicks contractions and can be similar to a forceful menstrual cramp. These contractions are not usually a sign of beginning labor but should be reported for evaluation. A rhythmic pattern of even very light but persistent contractions could be a beginning sign of preterm labor. Exercise or rest does not reduce the frequency of Braxton Hicks contractions.
A nurse is 5 weeks pregnant and works on a care area where chemotherapy is administered to patients. Which statement indicates that this nurse needs additional health teaching about avoiding teratogens during pregnancy? A) "I care for about five patients a day." B) "I find giving emotional support taxing." C) "Latex gloves irritate my hands, so I don't use them." D) "I never accompany patients to the X-ray department."
C) "Latex gloves irritate my hands, so I don't use them." The nurse is not using latex gloves and is expsed to chemotherapeutic agents, which are known as teratogens during pregnancy. This nurse needs additional instruction to reduce exposure from the chemotherapy agents. Caring for five patients a day does not necessarily increase the nurse's exposure to teratogens. Emotional support does not increase the nurse's exposure to tertaogens. Avoiding x-rays is a positive action to avoid teratogens.
A pregnant patient is concerned that she is allergic to something because her hands have been red and itchy since becoming pregnant. What should the nurse explain as the cause of the patient's symptoms? A) Allergy to fetal protein B) Reduced serum protein C) Increased estrogen level D) Chorionic gonadotropin hormone secretion
C) Increased estrogen level Palmar erythema, or palmar pruritus, occurs in early pregnancy and is probably caused by increased estrogen levels. Constant redness or itching of the palms can make a woman believe she has developed an allergy. This type of itching in early pregnancy is normal and is not caused by an allergy to fetal protein, reduced serum protein, or chorionic gonadotropin hormone secretion.
The nurse is reviewing the signs of labor with a patient entering the last phase of the third trimester of pregnancy. What should the nurse include as an indication that the labor is beginning? A) Excessive fatigue and headache B) Sharp, right-sided abdominal pain C) Sudden gush of clear fluid from the vagina D) An increased pulse rate and upper abdominal pain
C) Sudden gush of clear fluid from the vagina Labor may begin with rupture of the membranes, experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina. Excessive fatigue, headache, abdominal pain, or increased pulse rate are not indications the labor is beginning.
A pregnant patient who works as a secretary at a large corporation wants to take a leave of absence from work but is afraid of losing seniority. What should the nurse advise the patient? A) The patient should not ask for special favors. B) The leave of absence should occur after the baby is born. C) The employer cannot penalize the patient for being pregnant. D) It is not wise for any woman to work past the seventh month of pregnancy.
C) The employer cannot penalize the patient for being pregnant. Women who are unable to continue working while pregnant are protected from loss of employment benefits during pregnancy by federal law. According to federal law, an employer cannot deprive woman of seniority rights because they take a maternity leave. The patient is not asking for special favors. The maternity leave can occur before the delivery because the Family Medical and Leave Act can be used once the baby is delievered. There is no time limit about how long a pregnant patient can work.
During the previous prenatal visit, the nurse instructed a pregnant patient on ways to reduce the impact of varicosities. Which patient statement indicates that additional teaching is needed? A) "I drink fluid throughout the day." B) "I'll try not to stand for long periods." C) "I point my toes up and down frequently." D) "I wear knee-highs rather than pantyhose."
D) "I wear knee-highs rather than pantyhose." For varicosities, the patient should be instructed to avoid constrictive knee-high hose. Fluid intake, avoiding prolonged positions, and dorsiflexion of the feet are ways to reduce the impact of varicosities and would not require additional teaching.
A pregnant patient enjoys exercising at a local health spa once a week. Which patient comment indicates to the nurse that additional health teaching is needed? A) "I'm learning to play table tennis." B) "I limit exercising to low-impact aerobics." C) "The gym gets hot and stuffy by midmorning." D) "Nothing feels nicer than a hot tub soak after exercise."
D) "Nothing feels nicer than a hot tub soak after exercise." Pregnant women should not soak for long periods in extremely hot water or hot tubs because heat exposure for a lengthy time could elad to hyperthermia in the fetus and birth defects, specifcally esophageal astresia, omphalocele, and gastroschisis. Playing table tennis, performing low-impact aerobics, and the environment of the gym are not comments that indicate the need for additional teaching.
What advice should the nurse provide to a patient who is 4 months pregnant and owns a cat? A) Give it away until after delivery. B) Refrain from cleaning the cat's dish. C) Be careful that it doesn't scratch the skin. D) Ask someone else to change the cat litter
D) Ask someone else to change the cat litter Toxoplasmosis, a protozoan infection may be contracted through handling cat stool in soil or cat litter. Removing a cat from the home during pregnancy as means of prevention is not necessary as long as the cat is healthy. The pregnant woman should be instructed not to change a cat litter box or garden in soil in an area where cats may defecate to avoid exposure to the disease. Cleaning the cat's dish is acceptable. Scratches do not cause the disease.
A pregnant patient is planning travel to a foreign country as part of a work assignment and needs immunizations. What should the nurse instruct the patient about immunizations while pregnant? A) Immunizations should be restricted to live viruses only. B) There are no restrictions on immunizations while pregnant. C) The only immunization that should be avoided is for the flu. D) Live virus immunizations are contraindicated while pregnant.
D) Live virus immunizations are contraindicated while pregnant. All live virus vaccines are contraindicated during pregnancy and should not be administered unless the risk of the disease outweighs the risk to the pregnancy because live virus vaccines can cross the placenta and infect the fetus. The influenza vaccine is recommended if it is flu season when visiting crowded locations.
A pregnant patient is concerned that orgasm will be harmful to the developing fetus. What should the nurse include when responding to this patient's concern? A) Orgasm during pregnancy is potentially harmful. B) Venous congestion in the pelvis makes orgasm painful. C) Most women do not experience orgasm during pregnancy. D) Some women experience orgasm intensely during pregnancy.
D) Some women experience orgasm intensely during pregnancy. Because of increased pelvic congestion from the additonal uterine blood supply at midprenanacy, most women notice increased clitoral sensation and may experience oragsm for the first time during prenancy because of this. Orgasm during prenancy is not harmful. Pelvic congestion does not make the orgasm painful.
An adolescent asks which sport would be safe for her to learn during pregnancy. Which activity should the nurse suggest to the patient? A) Skiing B) Jogging C) Bicycling D) Swimming
D) Swimming Swimming is a good activity for pregnant women and is not contraindicated as long as membranes are intact. It increases muscle tone but may help relieve backache. Pregnancy is not the time to learn to ski or irde a bicycle because the lack of skill could result in many falls. Jogging is questionable because of the strain the extra weight of pregnancy places on the knees.
The nurse is emphasizing the importance of adequate rest and sleep with a pregnant patient. Which position should the nurse suggest the patient use? Select one: a. On the back with a pillow under the head b. On the stomach with a pillow under her breasts c. On the back with a pillow under the knees and hips d. On the side with the weight of the uterus on the bed
d. On the side with the weight of the uterus on the bed A good resting or sleeping position for a pregnant paitent is a left-sided Sims' position, with the top leg foward. This position puts the weight of the fetus on the bed, not on the woman, and allows good circulation in lower extremitites. Lying on the back could cause the weight of the uterus to occlude the inferior vena cava impeding blood flow to the paitent and fetus. Sotmach lying is not a reasonable option with the size of the uterus.
