OB Ch. 8 Nursing Care of the Family During Pregnancy

The primary health care provider has ordered 300 mcg of immunoglobulin to be delivered intramuscularly to a pregnant patient. What would be the reason for administering this to the patient? 1 The patient is Rh negative and unsensitized. 2 The patient has elevated amniotic fluid volume. 3 The patient has group B streptococcal infection. 4 The patient is human immunodeficiency virus (HIV) positive.

1 A patient who is Rh negative or Rh unsensitized should receive 300 mcg immunoglobulin to prevent complications in the fetus related to Rh incompatibility. Elevated amniotic fluid volume (or polyhydramnios), streptococcal infection, and HIV infection cannot be treated with immunoglobulin. Severe polyhydramnios is treated by aspirating a small amount of amniotic fluid (amniocentesis). If a patient tests positive for group B streptococcal infection, antibiotic therapy is initiated. If the pregnant patient is HIV positive, antiretroviral drugs are administered to prevent transmission of infection from the mother to the child.

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? 1 The patient weighs 59 kg. 2 The patient weighs 62 kg. 3 The patient has good-quality sleep. 4 The patient has regular bowel moments.

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 suggesting different ways to prevent complications during pregnancy. What suggestion will the nurse give to a patient to prevent human papillomavirus (HPV) infection? 1 "Take measures for safer sex." 2 "Consume cranberry juice daily." 3 "Undergo immunization for HPV." 4 "Perform Kegel exercises regularly."

1 HPV is a sexually transmitted infection. Moreover, this infection crosses the placental barrier and may affect the fetus. To prevent this infection, the nurse would counsel the pregnant patient to take proper safety measures during sexual intercourse, such as using condoms. Kegel exercises are helpful in strengthening the pelvic floor muscles and preventing urinary incontinence. Drinking cranberry juice regularly is beneficial for preventing urinary tract infection. HPV immunization or live virus immunization is not recommended during pregnancy.

The nurse is assessing a pregnant and anemic patient who is at risk for developing peripartum hemorrhage. Which laboratory test does the nurse expect the primary health care provider to order for this patient? 1 Hematocrit 2 Serology test 3 Hemoglobin test 4 Transvaginal ultrasound

1 Hematocrit testing is recommended for the pregnant patient suffering from anemia who may be at high risk for peripartum hemorrhage. Serologic tests are performed to detect infection-causing organisms in the blood. Hemoglobin levels do not cause hemorrhage in the patient. However, anemia is a complication associated with hemorrhage. Transvaginal ultrasound is performed to confirm cervical length and assess the risk for preterm birth.

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

1 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.

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 Place a small towel under the patient's right hip. 2 Place the patient on her right side while the measurement is done. 3 Use a new paper tape measure for each visit to decrease infection. 4 Place a pillow under the patient's knees whenever she is on her back.

1 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.

Which behavioral change does the nurse observe in the spouse/partner of a pregnant patient during the focusing phase? 1 Engages in building a relationship with the newborn 2 Has difficulty accepting changes in life plans and lifestyles 3 Engages in discussions with others about the philosophy of life 4 Engages in extramarital affairs because of a lack of partner's attention

1 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 evaluates a patient's cardiac function frequently. What is the reason for assessing the cardiac function frequently? 1 The patient has multiple fetuses. 2 The patient has an early pregnancy. 3 The patient has burning sensation in chest. 4 The patient has undergone bariatric surgery.

1 The patient who has multifetal pregnancy is at a high risk for developing cardiac dysfunction as a result of compression of the major vessels by the abdominal contents. Therefore the nurse would regularly monitor cardiac activity in this patient. Women who get pregnant early are not at risk for developing cardiac complications. Pregnant patients with a history of bariatric surgery should be frequently assessed for the signs of impaired nutrition. A burning sensation in the heart during pregnancy indicates gastric problems. Changes in the patient's diet and relaxation techniques are recommended for these complaints.

The nurse is assessing a pregnant patient who already has a 2-year-old child. During assessment, the nurse tells the child to listen to the fetal heartbeat. What is the objective of this nursing intervention? 1 To develop a bond between the child and the newborn 2 To understand the feelings and perceptions of the child 3 To help develop a bond between the child and the mother 4 To make the child feel comfortable in the health care center

1 Usually children have sibling rivalry with the arrival of a newborn in the family. To help develop the bond between the newborn and the child, the nurse should ask the child to listen to the fetal heart rate. The nurse can also advise the mother to bring the child along during prenatal checkups. The nurse should advise the mother to spend time and play with the child, because this helps to develop a strong bond. The child can be involved in activities such as drawing and painting, because this helps reveal the feelings and perceptions of the child. The nurse can give some toys to the child while assessing the mother. This helps make the child feel comfortable, and the child will not disturb the mother during the test.

Which signs and symptoms in a pregnant patient would the nurse attribute to elevated levels of estrogen? Select all that apply. 1 Gingivitis 2 Angiomas 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.

A patient who is in the first trimester of pregnancy complains of increased frequency of urination. What will the nurse advise the patient? Select all that apply. 1 "Use a perineal pad." 2 "Take bubble baths regularly." 3 "Empty the bladder regularly." 4 "Perform Kegel exercises regularly." 5 "Increase fluid intake before bedtime."

1, 3, 4 During pregnancy, the bladder's function is altered by the changes in hormone levels. Therefore the bladder's capacity to hold urine is reduced as the uterus is enlarged. These changes result in increasing urgency and frequency of urination. The nurse should advise the patient to use a perineal pad because it absorbs urine leakage and keeps the perineum dry. The nurse advises the patient to perform Kegel exercises to strengthen the pelvic muscle and improve the muscle tone, which helps manage urination problems. The patient should empty her bladder regularly to prevent urinary infection. The nurse should instruct the patient to avoid bubble bath because it can irritate the urethra. The patient should not increase fluid intake before bedtime because it increases the frequency of urination and disturbs the patient's sleep. Therefore the nurse should advise the client to limit fluid intake before bedtime.

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

The nurse is assessing a pregnant patient who has gained 25 kg in the third trimester of pregnancy. The nurse informs the patient that this weight gain is expected. What conditions would have led the nurse to consider this weight gain normal? 1 The patient has a family history of obesity. 2 The patient has a pregnancy with multiple fetuses. 3 The patient has her first pregnancy in her late 30s. 4 The patient has developed gestational hypertension.

2 A pregnant patient with multiple fetuses usually gains 25 kg during pregnancy. Otherwise, a 25-kg weight gain during pregnancy is not common even if the patient has a family history of obesity. Late pregnancy or gestational hypertension does not cause obesity in pregnant women, nor does age. In such a case, if the pregnant patient is obese the nurse should plan a diet and exercise regimen that will help her lose weight.

A pregnant woman at 32 weeks of gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. What is the nurse's initial response? 1 To raise the woman's legs 2 To turn the woman on her side 3 To have the woman breathe into a paper bag 4 To assess the woman's blood pressure and pulse

2 During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Vital signs can be assessed next. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Raising her legs will not solve the problem because pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output.

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 "Get regular back rubs." 2 "Increase your fluid intake." 3 "Take bubble baths regularly." 4 "Include dry carbohydrates in your diet."

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.

While examining the breasts of a pregnant patient, the nurse observes that the patient has inverted nipples. What does the nurse interpret from this finding? 1 The patient has to apply iodine tincture on the nipples. 2 The patient's baby will probably have difficulty latching. 3 The patient has had breast reduction surgery in the past. 4 The patient has normal breast changes during pregnancy.

2 Inverted nipples affect the infant's ability to latch onto the breast, so the infant will have difficulty sucking the nipple during breastfeeding. Scars on the breast are an indication of previous breast reduction surgery. Tinctures should not be applied to the breast because they remove protective oils that keep nipples supple. This may cause cracks on the nipple during early lactation. A normal nipple will stand erect when pressure is applied. Therefore, presence of inverted nipples is not a normal finding during pregnancy.

What does the nurse advise the woman who wants to have a nurse-midwife provide obstetric care? 1 She will have to give birth at home. 2 She must be having a low risk pregnancy. 3 She will not be able to have epidural analgesia for labor pain. 4 She must see an obstetrician as well as the midwife during pregnancy.

2 Midwives usually see low-risk obstetric patients. Care is often noninterventional, with active involvement from the woman and her family. Nurse-midwives must refer patients to physicians for complications. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer patients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited.

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. The pregnant patient should not stand for prolonged periods in order to lower the risk for what? 1 Leg cramps 2 Preterm labor 3 Carpal tunnel syndrome 4 Thrombophlebitis in the legs

2 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.

The nurse is assessing a couple as part of a prenatal interview. On assessment, the nurse finds that the patient has previously undergone uterine surgery for fibroids. What will the nurse tell the patient? 1 "You may be at risk for preterm delivery." 2 "You may need a cesarean to deliver the baby." 3 "You may be at risk for having postpregnancy allergies." 4 "You may give birth to a child with congenital anomalies."

2 The patient with the history of uterine surgery or extensive pelvic surgery may need a cesarean to avoid further damage to the uterine muscle and to avoid complications during pregnancy. There is no evidence that a patient who has undergone uterine surgery will have preterm delivery; it is more often seen in obese patients. Postpregnancy allergies may occur in immunocompromised patients. Chromosomal abnormalities or genetic abnormalities may cause congenital anomalies in the fetus. Because the client is not immunocompromised and does not have genetic abnormalities, there is no risk for allergies in the mother or congenital anomalies in the child.

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? 1 "Increase food intake." 2 "Repeat the test at 28 weeks." 3 "Undergo a renal function test." 4 "Undergo a 3-hour glucose test."

2 The pregnant patient has a family history of diabetes and may be at a 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.

The nurse is assessing the fundal height of a pregnant patient. During the assessment, the nurse observes that the patient has difficulty breathing and is sweating profusely. After recording the heart rate and blood pressure of the patient, the nurse changes the patient's position. What is the rationale for this nursing intervention? 1 The patient has excess body weight. 2 The patient has supine hypotension. 3 The patient has gestational hypertension. 4 The patient has respiratory tract infection.

2 While the nurse measures the fundal height, the patient lies on her back. In this position the abdominal contents may compress the vena cava or the aorta, thus causing supine hypotension. Supine hypotension is characterized by symptoms such as sweating, difficulty breathing, and tachycardia. The nurse would position the patient in the lateral position until the symptoms subside. Supine hypotension may be observed in any pregnant patient; it does not indicate that the patient is overweight. In gestational hypertension the patient's blood pressure is elevated and is not affected by the patient's position. The breathlessness developed in this condition is not caused by respiratory tract infection. Respiratory tract infection is characterized by other signs such as fever and cough.

After assessing a pregnant patient, the nurse determines that the patient has supine hypotension. Which symptoms does the nurse observe in the patient? Select all that apply. 1 Fever 2 Pallor 3 Dizziness 4 Faintness 5 Numbness

2, 3, 4 Supine hypotension occurs when the pregnant patient lies on her back. This is caused by compression of the vena cava and aorta by the abdominal contents. Supine hypotension is characterized by pallor (pale color skin), dizziness, and faintness. Clammy (damp, cool) skin is also seen in supine hypotension. Supine hypotension does not affect body temperature. Therefore, fever is not an indication of supine hypotension. Unlike carpal tunnel syndrome, supine hypotension does not result in numbness.

The nurse is assessing the fetal heart rate in a pregnant patient. The nurse finds asynchronous fetal heartbeats during auscultation. In which condition would this finding be considered normal? 1 Late pregnancy 2 First pregnancy 3 Multifetal pregnancy 4 Surrogate pregnancy

3 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 is considered a normal sign in a patient who has multiple fetuses. Asynchronous fetal heartbeats is an abnormal sign during late pregnancy, first pregnancy, and surrogate pregnancy. In these conditions, asynchronous fetal heartbeats indicate cardiac dysfunction in the fetus.

During the prenatal checkup, a patient in the third trimester reports difficulty sleeping. What does the nurse suggest to the patient to promote good sleep? Select all that apply. 1 "Take an oil bath twice a day." 2 "Drink acidophilus milk regularly." 3 "Drink warm milk before going to bed." 4 "Get a back massage or effleurage regularly." 5 "Place a pillow under the back while sleeping."

3, 4, 5 Insomnia occurs in the third trimester of pregnancy because of fetal movements, muscle cramping, urinary frequency, shortness of breath, and other discomforts. The nurse advises the patient to drink warm milk before going to bed because it helps promote sleep. Back massage or effleurage provides muscle relaxation, which in turn promotes good sleep. The nurse instructs the patient to support body parts with pillows while sleeping because it makes the patient feel comfortable and relaxed. Acidophilus milk helps prevent uterine infections, not insomnia. Oil baths help prevent pruritus, not insomnia.

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. What does the nurse tell her? 1 "Because you're in your second trimester, you can drink as much as you like." 2 "One drink every night is too much. One drink three times a week should be fine." 3 "Because you're in your second trimester, there's no problem with having one drink with dinner." 4 "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."

4 Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised. Regardless of which trimester the woman has reached, no amount of alcohol during pregnancy has been deemed safe for the fetus. Neither one drink per night nor three drinks per week is a safe recommendation. Although the first trimester is a crucial period of fetal development, pregnant women of all gestations are counseled to eliminate all alcohol from their diet. A safe level of alcohol consumption during pregnancy has not yet been established.

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? 1 "Drink mineral oil before going to bed." 2 "Discontinue taking iron supplements." 3 "Take a stool softener before going to bed." 4 "Drink six to eight glasses of water every day."

4 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.

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? 1 "Your partner should be advised to play with children." 2 "Your partner should visit an orphanage for a few days." 3 "Your partner should be encouraged to develop a new hobby." 4 "Your partner should be given adequate time to adapt to the idea of having a baby."

4 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.

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? 1 Elevated estrogen level 2 Elevated progesterone level 3 Elevated serum calcium level 4 Elevated serum phosphorus level

4 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.

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

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

4 From the assessment, the nurse concludes that development of the fetus is normal at 28 weeks of 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.

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware of what? 1 No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus. 2 The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. 3 Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. 4 Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.

4 Prescription and OTC drugs 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 postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

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? 1 Polyhydramnios 2 Multifetal gestation 3 Maternal malnourishment 4 Intrauterine growth restriction (IUGR)

4 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 of gestation. What does the nurse infer this is a sign of? 1 Intrauterine fetal death 2 Renal calculus in the patient 3 Gestational diabetes mellitus 4 Premature rupture of membrane

4 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.

A patient who is 6 months pregnant asks about proper placement of her seatbelt. Teaching by the nurse has been successful if the patient makes which statement? 1 "I need to position the lap belt loosely directly over my bellybutton." 2 "I need to place the lap belt portion snugly over the upper part of my uterus." 3 "I need to place the seatbelt directly over the widest part of my abdomen." 4 "I need to place the lap belt portion low across my hip bones as snugly as is comfortable."

4 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. Correct application involves making sure that the seatbelt was fastened securely. Positioning the lap belt loosely over the bellybutton does not indicate correct placement.

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? 1 "Use soap." 2 "Use alcohol." 3 "Apply tincture." 4 "Rinse with warm water."

4 Warm water increases blood circulation and prevents blockage of the ducts with dried colostrum. Therefore the nurse should advise the patient to clean her nipples with warm water. The nurse should advise the patient to avoid using soap, tincture, or alcohol to clean her nipples because these substances remove the protective oils that keep the nipples supple. Use of these substances may cause cracks on the nipple during lactation.