OB: Chapter 12: Nursing Management During Pregnancy

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 asks the nurse to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be:

April 27.

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

Baseline data is collected.

Which statement is true regarding sexual activity and pregnancy?

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

A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?

Eat small meals frequently rather than large meals.

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?

Wear support hose.

The nurse should administer Rho(D) immune globulin to the pregnant woman who is Rho(D)-, after which test?

amniocentesis

The nurse advises a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent?

heartburn

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?

near the bottom of the sternum

Which nursing intervention is appropriate when preparing a woman for an amniocentesis?

Be certain she knows that there are risks of complication, such as premature labor, from amniocentesis.

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.

If constipation is a problem for a woman during pregnancy, which measure would be best to recommend?

increasing fluid intake

An adolescent who is pregnant asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe?

swimming

During the health assessment of a pregnant client who is 30 years old, the nurse discusses preventive breast care. Which recommendation would the nurse include?

"A breast examination by a health care provider can help detect if there are any structural problems that may affect breastfeeding." Breast self-examination is no longer thought to yield enough reliable information to be continued as a monthly self-care routine, but women should be alerted to normal breast changes during pregnancy and about the responsibility to begin having mammograms when they reach 40-45 years of age. Clinical breast examination in women of average risk has not been shown to be effective in average risk women at any age. However, it may be helpful in identifying any anatomical issues with breastfeeding that may occur Confirm whether a woman has had a human papillomavirus (HPV) vaccine as many women are not yet aware the vaccine has the potential to not only prevent HPV infections but also prevent cervical cancer; it is not associated with breast cancer, however.

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."

In light of the high incidence of some illnesses in women, which question is most important to include in a review of systems for a pregnant woman?

"Have you had any urinary tract infections?" Urinary tract infections occur at a greater incidence in pregnant women than in others because stasis of urine occurs because of pressure on the ureters; the trace of glucose often present in urine helps bacteria grow.

Which statement by the pregnant woman shows an understanding that she should avoid teratogens in the first trimester?

"I have to call my doctor to switch me from lithium to another drug for my bipolar disorder. It is very important for women to avoid teratogens during the first-trimester period (weeks 2 to 8 after conception) because all major fetal organs are formed. Lithium, tetracycline, alcohol, and exposure to radiation all are considered teratogens. The only statement that reflects an understanding is Option D.

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching?

"I wear knee-highs rather than pantyhose."

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 nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.

At her 12-week prenatal visit, the primagravida states, "I haven't felt my baby move yet. What is wrong?" What is the best response to the client?

"The fetus kicks regularly, although the pregnant woman usually cannot feel the movements until approximately 16 to 20 weeks."

A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best?

"Your statistical risk of another tubal pregnancy is increased." If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.

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.

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 diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

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. There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.

The first time the nurse sees a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?

20 weeks

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 pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:

30111.

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.

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?

6.5%

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 client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort?

Avoid consumption of caffeinated drinks.

A nurse is teaching a group of primigravida woman 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. Only a few complications of pregnancy such as vaginal bleeding and ruptured membranes limit sexual activity. A partially dilated cervix does not warrant a restriction in sexual activity.

During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam?

Chadwick's sign During the speculum examination, the practitioner obtains a Papanicolaou test or Pap smear and notes signs of pregnancy, such as Chadwick's sign.

A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy?

Client does not have an incompetent cervix.

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 midmorning. The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

A woman in her 20s explains to the nurse that she would like to eat more healthy foods during her pregnancy but complains about the high cost of food. She confides that she just makes minimum wage at her job and that things are tight for her financially. What would be the most appropriate intervention for the nurse to make?

Discuss the WIC program with the client.

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. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?

Eat dry crackers or toast before rising.

A nurse is conducting a program for a group of women in a community health about the importance of prenatal care. Which information would the nurse include when describing its purpose? 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. The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

A fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which instructions should the nurse give to the client? Select all that apply.

Exercise three times weekly for 30 consecutive minutes. Include warm-up and cool-down exercises. Avoid sports that involve body contact. Avoid taking up a new sport, such as cycling, during pregnancy. Walking is an excellent exercise option during pregnancy.

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. Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

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. Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

A pregnant client arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks gestation. How will the nurse document her "G" and "L" for her records?

G3 L2

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?

G3 P0020

A client has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history?

G3, P2

A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart?

G5 P3114

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding.

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How does the nurse record her obstetric history on the chart using the GTPAL format?

G5 T2 P1 A1 L3 One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for preterm, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation. "L" is for living, the number of children delivered who are alive at the time of history collection.

A client presents to the office for her obstetric history. She tells the nurse she has 4 children living at home. One child was born at 34 weeks, another child at 37 weeks, two were born consecutively at 38 and 39 weeks, and one was aborted. Record the client's obstetric record using the GTPAL format.

G5, T2, P2, A1, L4

A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?

Health-seeking behaviors related to ways to relieve discomforts of pregnancy

A nuse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply.

Individualized assessment Counseling Teaching Nurses contribute to the success of prenatal care through individualized assessment, counseling, and educating. Assistance with social coordination and authoritarian decision making are not associated with successful prenatal care.

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.

Why is a Papanicolaou smear done at the first prenatal visit?

It identifies abnormal cervical cells.

A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?

Maintain tolerable intensity of exercise.

A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office?

Make a follow-up appointment.

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.

When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy?

famotidine Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Isotretinoin and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.

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. During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.

A client, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs the nurse of frequent low back pain and ankle edema by the end of the day. What interventions should the nurse suggest to relieve these discomforts?

Rest when possible with feet elevated at or above the heart.

The first day of the client's last menstrual period was December 1. Based on Naegle's rule, the nurse determines that which date is the estimated date of birth?

September 8

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 is planning on taking a vacation that involves extensive travel by automobile. Which guideline should the nurse give her?

Stop and walk every few hours.

When describing the role of a doula to a group of pregnant women, the nurse would include which information?

The doula primarily focuses on providing continuous labor support

A nonstress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which statement by the client indicates understanding of the test results?

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

A 24-year-old pregnant woman reports excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation, but she finds it messy and unpleasant. What should the nurse advise her to do?

Use sanitary pads. Vaginal discharge increases during pregnancy and is a concern for many women. Encourage the client to keep clean and wear sanitary pads as needed. Douching may be dangerous for the mother. STIs are not indicated simply by discharge. Pregnant women should not decrease fluid intake.

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?

alpha-fetoprotein analysis Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The Doppler flow study evaluates the blood flow, and amniocentesis evaluates the contents of the amniotic fluid looking for chromosomal defects.

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

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 The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet.

During pregnancy the cardinal rule regarding taking medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?

asthma

A nurse at the health care facility assesses a client in the 20th week of 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

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

at the umbilicus

Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes?

between 24 and 28 weeks' gestation All women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.

A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information?

biophysical profile A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detected via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.

What anatomic area should be examined when assessing Montgomery tubercles?

breasts

Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?

clean catch urine

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

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.

Some women contract with other women to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who is contracted?

doula The woman may contract with a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?

episodes of double vision

Leah is 28 weeks pregnant. To prepare her for discomforts that occur during the final trimester of pregnancy, what would the nurse teach her about?

experiencing increased shortness of breath and dyspnea before lightening

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

facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension

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 Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tub use.

A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?

gravida 4, para 2

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 Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.

The nurse advises a pregnant client to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition?

nausea and vomiting

When discussing rest and sleep with a pregnant woman, the nurse would suggest which position for napping?

on her side with the weight of the uterus on the bed

A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will move the same amount every day. The nurse also adds that the client may notice an unusual increase or decrease in movement, explaining that this is due to which situation?

response to a need for oxygen A fetus normally moves more or less the same amount every day. If there is an unusual increase or decrease in movement, the client should be examined because such a change suggests that the fetus is responding to a need for oxygen.

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 Maternal exposure to rubella during pregnancy poses a particular fetal risk that supersedes the significance of hepatitis, measles, diphtheria, tetanus, or pertussis.

A pregnant client is asking about medications, supplements, and vaccines. Which would the nurse indicate as potentially teratogenic?

rubella vaccine

During the first prenatal visit an extensive history is collected from the client. What is one part of this extensive history?

social history

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 soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?

the use of OTC drugs with teratogens Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.

A pregnant client has come to a health care provider for her first prenatal visit. The nurse needs to document useful information about the past health history. What are goals of the nurse in the history-taking process? Select all that apply.

to prepare a plan of care that suits the client's lifestyle to develop a trusting relationship with the client to prepare a plan of care for the pregnancy

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