Prenatal Care
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." -"If my AFP level is negative, it means the baby has no birth defects." -"If my AFP level is low, then I won't need to follow up." -"If there is a need to get my AFP level tested, a blood sample will be obtained around 11 weeks."
"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." Explanation: 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.
The nurse is conducting the first prenatal assessment on a new client. She shares with the nurse she has 3 children, 2 born at full-term and one at 34 weeks' gestation. Her last pregnancy ended in a miscarriage. How should the nurse document this client's obstetrical history? -G3 T2 P1 A1 L3 -G4 T3 P0 A1 L3 -G4 T2 P1 A1 L3 -G5 T2 P1 A1 L3
-G5 T2 P1 A1 L3 Explanation: 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 including the current one. "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 to include miscarriage. "L" is for living, the number of children delivered who are alive at the time of history collection.
A primigravida client has presented for her first prenatal visit and is concerned about the potential weight gain and the struggle to lose the weight after the baby's birth. How much weight should the nurse recommend this client with a normal BMI gain during her pregnancy to ensure a healthy fetus? -15 to 20 lbs -20 to 25 lbs -30 to 35 lbs -10 to 15 lbs
30 to 35 lbs Explanation: The nurse should convey that weight gain is healthy and that the client with a normal BMI should gain 30 to 35 lb (13.6 to 15.8 kg) to ensure a healthy fetus.
The nurse is caring for a client in her second trimester who requires follow-up genetic testing after a common screening indicated a potential abnormality. What is the nurse's main role at this time? -Facilitating the testing process -Allowing the client to vent feelings -Answering any questions regarding potential abnormalities -Witnessing the signature of the genetic testing
Allowing the client to vent feelings Explanation: It is a difficult time for the client and family. The nurse's main role is to support the client and family and allow the client to vent any feelings. The nurse will also assist in answering any questions but much of this information comes from health care provider. Next, the nurse will facilitate the testing process and witness the signature as the testing requires informed consent.
A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy? -Cardocentesis. -Amniocentesis. -Nuchal translucency testing. - Chorionic villi sampling.
Amniocentesis. Explanation: Amniocentesis to screen for congenital anomalies can be done starting at 14 weeks' gestation. This procedure carries risks of spontaneous abortion, infection, and placental abruption. Cardocentesis is used less commonly to determine blood disorders. Chorionic villi sampling is performed at 8 to 12 weeks' gestation. Nuchal translucency testing is done between 11 and 13 weeks' gestation.
The nurse is preparing a care plan for a primigravida client and her partner who are excited about her pregnancy and ask lots of questions on various subjects. Which nursing diagnosis should the nurse prioritize for this client and her partner in this care plan? -Health-seeking behaviors -Fear related to lack of knowledge -Risk of injury -Deficient knowledge
Deficient knowledge Explanation: The most appropriate nursing diagnosis in this case would be "deficient knowledge." This can entail various topics to include nutrition, exercise, testing, and even the sex of the baby. The other choices are also potential nursing diagnoses but would involve other types of activities. The couple is not displaying fear but are seeking information that will help them be successful with their pregnancy.
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, P1, A1, L3 -G4, T3, P0, A1, L3 -G5, T2, P2, A1, L4 -G4, T3, P1, A1, L4
G5, T2, P2, A1, L4 Explanation: "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or induced (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).
Which question should the nurse include when conducting a review of systems with a patient during the first prenatal visit? - "Do you have a peptic ulcer?" -"Have you ever had a heart attack?" -"Have you had any neurologic diseases?" -"Have you had any urinary tract infections?"
Have you had any urinary tract infections?" Explanation: Urinary tract infections are associated with preterm birth. If the patient has a history of this type of infection, then interventions can be directed to help the patient avoid a urinary tract infection while pregnant. Although a part of the review of systems, asking about peptic ulcers, heart attacks, and neurologic diseases may not have as significant an impact on the developing fetus as having urinary tract infections.
A nurse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply. -Individualized assessment -Assistance with social coordination -Counseling -Authoritarian decision making -Teaching
Individualized assessment Counseling Teaching Explanation: 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.
A nurse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply. -Individualized assessment -Assistance with social coordination -Counseling -Authoritarian decision making Teaching
Individualized assessment Counseling Teaching Explanation: 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.
When explaining what will occur during the first prenatal visit physical examination, a pregnant patient asks why a Papanicolaou smear is being done at this time. What should the nurse respond to the patient? -t helps to date the pregnancy. -It detects if uterine cancer is present. -It predicts whether cervical cancer will occur. -It detects cancer cells of the cervix, vulva, or vagina.
It detects cancer cells of the cervix, vulva, or vagina. Explanation: A Pap smear is taken from the endocervix at a first prenatal visit to be certain a precancerous or cancerous condition of the uterine cervix, vulva, or vagina is not present. A Pap smear is not used to date a pregnancy, detect uterine cancer, or predict if cervical cancer will occur.
The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? -All activities that the client does in a prepregnant state -Relaxing activities such as those including hot baths and jacuzzis -High impact movements enabling less time in the activity -Stretching and breathing exercises such as yoga
Stretching and breathing exercises such as yoga Explanation: It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high impact sports are not appropriate for the pregnant mother. Hot areas such as in a jacuzzi, hot tub and sauna are also inappropriate.
A nurse is assessing a pregnant client. Which of the following would the nurse document as an abnormal finding in a pregnancy? -Lordosis -Pedal edema -Linea nigra -Visual changes
Visual changes Explanation: Visual changes are not seen in a normal pregnancy. They are only seen in the case of pregnancy-induced hypertension. Lordosis, pedal edema, and linea nigra are changes seen in a normal pregnancy.
A pregnant client at 26 weeks' gestation has arrived for a routine prenatal visit. Which assessments should the nurse prioritize? Select all that apply. -blood pressure -weight -edema of the face and hands -urine testing -blood glucose level
blood pressure weight urine testing blood glucose level Explanation: Up to the 28th week of gestation, follow-up visits involve assessment of the client's blood pressure and weight, urine testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks' gestation; however, edema of the face and hands should be reported if noted sooner.
When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? -hemoglobin and hematocrit -urine for culture -fetal ultrasound -fundal height measurement
fundal height measurement Explanation: On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the woman's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.
The nurse is assessing the latest laboratory results of a pregnant client who is at 17 weeks gestation. The nurse should prepare to teach the client about which possible defects after noting the maternal serum alpha-fetoprotein level is elevated above normal? -fetal hypoxia -open spinal defects -Down syndrome -maternal hypertension
open spinal defects Explanation: Elevated MSAFP levels are associated with open neural tube defects, underestimation of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight, oligohydramnios, material age, diabetes, and decreased maternal weight. Lower-than-expected MSAFP levels are seen when fetal gestational age is overestimated or in cases of fetal death, hydatidiform mole, increased maternal weight, maternal type 1 diabetes, and fetal trisomy 21 (Down syndrome) or 18. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. Maternal hypertension would be noted via serial blood pressure monitoring.
