OB-Exam 2
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? "I only work four hours a day so I don't get exposed too much." "The gloves they provide irritate my hands, so I don't use them." "There hasn't been a chemical spill in three years." "I have an assistant helping me now to handle the chemicals."
"The gloves they provide irritate my hands, so I don't use them." There are various chemicals which are recognized for their teratogenic effects and must be avoided during pregnancy. The nurse should find out which chemicals the client is exposed to and determine the risk factor. The greatest danger is the client handling chemicals without a barrier protection such as gloves. The other issues may also be dangers depending on the chemicals and the environment in which the client is working and should also be evaluated.
What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy? Assess a list she makes describing a good diet. Ask her to describe her total intake for a week. Assess her skin for hydration and color. Ask her to describe her intake for the last 24 hours.
A 24-hour food intake history is the best method to assess food intake in all individuals.
A nurse is giving a prenatal class on teratogens that have an affinity for specific body tissues. Which teratogen is accurately paired with the specific body tissue affected? Lead attacks the joints. Mercury attacks the nervous tissue. Tetracycline attacks the muscles. Thalidomide attacks the lungs.
A factor determining the effects of a teratogen is the teratogen's affinity for specific body tissues. Lead and mercury, for example, attack and disable nervous tissue. Thalidomide, originally used to treat nausea in pregnancy, is now prescribed for cancer therapy, and it may cause limb defects. Tetracycline, a common antibiotic, causes tooth enamel deficiencies, and possibly, long bone deformities.
A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment? having a hard time having bowel movements and feeling like anal area is swollen feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour experiencing some shortness of breath after walking up five flights of stairs having some discharge from nipples that has never happened before
A woman should report vaginal bleeding, no matter how slight, because some of the serious bleeding complications of pregnancy begin with only slight spotting. Constipation followed by hemorrhoid development is common with pregnancy. Walking up stairs during the third trimester does produce some shortness of breath. It is normal to have some colostrum, or pre-milk, discharge during pregnancy.
A nurse is reviewing the obstetric history of a pregnant woman who has come to the clinic for a visit. The history reveals that the woman is "gravida 3, para 2". Which interpretation by the nurse would be appropriate? Three previous pregnancies and two children born at term Two previous pregnancies, two children born at term, and currently pregnant Two previous preterm births and three miscarriages Three previous pregnancies and two preterm births
A woman who has had two previous pregnancies, given birth to two term children, and is pregnant again is gravida 3, para 2.
During prenatal education classes, a woman asks the nurse if she can continue her exercise program of going to the gym 3 to 5 times a week for cardio and a yoga class 1 to 2 times a week. Which information might the educator provide in terms of keeping blood sugar level adequate throughout the workout? "Sugar snacks like cookies will help boost your blood sugar levels before the workout." "If you forget to bring a snack, buy a soda from the machines in your work before working out." "Usually you will not need a snack before working out if you haven't had problems with blood sugars in the past." "Try to eat a protein and complex carb like cheese on wheat crackers before exercise."
Advise women to eat a protein and a complex carbohydrate such as peanut butter on whole wheat bread at least 15 minutes before exercise to keep blood sugar from falling during exercise, and to drink water before and after to prevent dehydration. Snacks are advisable prior to exercise. However, pregnant women should avoid pure carb snacks like cookies or canned sodas.
The nurse is assigned to clients who are having the following procedures: Amniocentesis Fetal nonstress test Chorionic villus sampling Percutaneous umbilical blood sampling Doppler assessment of fetal heart rate For which clients will the nurse ensure that the informed consent is on the chart?
Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.
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? Hypothyroidism Hemolytic anemia Electrolyte deficiencies Abnormal bleeding
Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.
In which situation is the nurse correct to document a reactive nonstress test? Select all that apply. At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip Decelerations in the fetal heart rate every 15 minutes The mother noting fetal movement and/or fetal kicks A lack of fetal movement over a 20 minute period
At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip The mother noting fetal movement and/or fetal kicks It is a reassuring factor to have a reactive nonstress test. A reactive test shows at least 2 accelerations of the fetal heart rate, variability of the heart rate noted in the monitor strip and the mother notes (which should be seen on the monitor strip as well) the fetus moving and/or kicking. Decelerations and a lack of fetal movement are concerning and will need to have further follow-up
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 nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? Perform nipple exercises and stimulation on a regular basis. Take a hot water bath or shower daily to maintain hygiene. Apply lanolin ointment to the nipple and areola to prevent cracking. 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 woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which action should the nurse suggest? Select all that apply.
Eat some saltine crackers before rising in the morning.Suck on sour candies.Delay breakfast until 10 or 11 AM.Try eating a snack before bedtime The traditional solution for preventing nausea is for women to keep dry crackers, such as saltines, by their bedside and eat a few before rising as increasing carbohydrate intake seems to relieve nausea better than any other nutrition remedy. Sucking on sour candies may serve the same purpose. A woman can then eat a light breakfast or delay breakfast until 10 or 11 am, past the time her nausea seems to persist. To be certain she maintains a good food intake during pregnancy even in the face of nausea, urge her to be certain to compensate for any missed meals later in the day; thus, eating two regular meals later in the day would not be adequate and could lead to hypoglycemia. Caution women against self-medicating for nausea by using a scopolamine patch, a drug used for motion sickness, as it is not intended for long-term use. Eating a snack before bedtime may be helpful so that delaying breakfast won't cause the woman to go a long time between meals.
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? dyspnea lower abdominal pressure swelling of extremities excessive vomiting
Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.
When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy? isotretinoin lithium warfarin 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 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 (G) indicates the number of pregnancies. When a nurse calculates the GTPA of a pregnant client, the current pregnancy counts and the three other pregnancies count for a total of four pregnancies. Para (P) indicates the number of pregnancies carried to viable gestational age. This client has had two viable pregnancies so far.
The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? Nosebleeds Heartburn Blood clots Constipation
Heartburn Filling the stomach with heavy food and fluid can cause overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone.
A nurse is giving a prenatal class on teratogens that have an affinity for specific body tissues. Which teratogen is accurately paired with the specific body tissue affected?
Mercury attacks the nervous tissue
The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? Heartburn Faintness Slowed GI transit time Nausea and vomiting
Nausea and vomiting Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.
Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman? Polio Rubella Rotavirus Diphtheria
Rubella (German measles) is an infection caused by the rubella virus. The virus causes a rash and mild symptoms in children but can be teratogenic to a fetus. A rubella titer determines if the mother is immune to the virus. If the mother is not immune, the mother will receive a rubella immunization immediately after delivery. Diphtheria and polio are infant vaccines but not as teratogenic to the fetus. Rotavirus is a gastrointestinal virus typically mild in adults.
A client with hyperemesis gravidarium is started on TPN. What parameter does the nurse need to assess at least twice a day? blood glucose hemoglobin and hematocrit blood ketones potassium level
The blood glucose level needs to be tested. If it is elevated, it suggests the concentration of glucose is too high for the body to metabolize.
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? clean catch urine initial blood tests measurement of fundal height ultrasound for fetal measurements
The first procedure a nurse should ask the client to do is obtain a clean catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or ultrasound done.
The nurse manager is orienting a new nurse in a clinic at the local prison. Which statements should the nurse manager include regarding the care of incarcerated pregnant clients? Select all that apply. The nurse manager is orienting a new nurse in a clinic at the local prison. Which statements should the nurse manager include regarding the care of incarcerated pregnant clients? Select all that apply. The nurse should discuss contraception as part of prenatal care. Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. Comprehensive prenatal care will be provided by the correctional facility health care team. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV.
The nurse should discuss contraception as part of prenatal care. Women who are incarcerated are more likely to have a high-risk pregnancy . The food served by the corrections facility may need to be adjusted for the pregnancy. Incarcerated pregnant women need to be screened for the use of tobacco, drugs, and alcohol. Incarcerated pregnant women need to be screened for sexually transmitted infections, including HIV. All of these are true, with the exception that comprehensive prenatal care is not provided by the correctional facility health care team. On-site medical staff, including nurses and other health care providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Care provided outside of the correctional facility is arranged in coordination with prison officers and on-site staff. Women who are incarcerated are more likely to have a high-risk pregnancy due to a higher incidence of current and past trauma, drug or alcohol use disorder, chronic illness, infections, smoking, and poor prenatal care and a lower socioeconomic status. As when caring for other pregnant women, the nurse regularly screens incarcerated pregnant women for sexually transmitted infections, including HIV, and the use of tobacco, drugs, and alcohol. The food made available by the corrections facility may need to be adjusted to exclude food that is unpasteurized as well as cold cuts or undercooked meat, which may contain pathogens dangerous in pregnancy. As with all pregnant women, the nurse should discuss contraception as part of prenatal care. Women are up to 15 times more likely to start contraception if it is offered during incarceration instead of delayed until it can be obtained in the community after release. Approximately half of incarcerated women become pregnant within 3 months of release from prison, making the provision of contraception prior to release particularly important.
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. Drink fluids with meals rather than between meals. Avoid an empty stomach at all times. Munch on dry crackers and toast in the early morning.
To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? prepregnancy BMI current weight height and bone structure hemoglobin level
Weight gain goal during pregnancy is based on the client's prepregnant BMI. Current weight and height are part of the BMI calculation. Hemoglobin level only provides information about iron stores, not overall nutritional status.
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth? severe dehydration resulting in hypoperfusion of the placenta ketonuria resulting in neurologic changes in the fetus poor nutrient intake resulting in poor fetal growth class B drugs used to control the vomiting resulting in uterine contractions
With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketouria impact the fetus' neurologic development, but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.
A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recomends which medication to provide some relief from the pain? ibuprofen aspirin products acetaminophen naproxen
acetaminophen Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.
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 top of the symphysis pubis halfway between the symphysis pubis and the umbilicus at the level of the umbilicus at the xiphoid process
at the level of the umbilicus In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.
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: increased risk of spontaneous abortion. decreased birth weight in neonates. increased risk of stillbirth. increased risk of placenta abruptio.
decreased birth weight in neonates. The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion is associated with caffeine use. Increased risks of stillbirth and placenta abruptio are associated with mothers addicted to cocaine.
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 the importance of healthy lifestyle family history of pregnancy complications importance of taking adequate vitamin and mineral supplements
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.
