PrepU antepartum/peripartum
A 38-year-old client and partner are carriers of the Tay-Sachs gene, have one child with Tay-Sachs, and are concerned to learn she is pregnant again. The nurse predicts the health care provider will order which test if the couple wants to know if this baby will also be born with Tay-Sachs? A multiple marker screening test Amniocentesis Chorionic villus sampling Percutaneous umbilical blood sampling
Chorionic villus sampling (CVS) is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.
A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. What statement would the nurse include when describing this test to the woman? "A needle will be inserted directly into your fetus's umbilical vessel to collect blood for testing." "A small amount of amniotic fluid will be withdrawn and collected for analysis." "An intravaginal ultrasound measures fluid in the space between the skin and spine." "A small piece of tissue from the fetal placenta will be removed and analyzed."
Chorionic villus sampling involves the removal of a small tissue specimen from the fetal portion of the placenta. Percutaneous umbilical cord sampling involves the insertion of a needle into the umbilical vessel. An amniocentesis involves the collection of amniotic fluid from the amniotic sac. Fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus.
A nurse is conducting a prenatal class for expectant mothers and one of the mothers asks her how the placenta works. The nurse would explain that the placenta serves which purposes? Select all that apply. The placenta provides nourishment for the fetus. It serves as an exchange site for oxygen and carbon dioxide. The placenta helps physically protect the fetus by surrounding the fetus with fluids. It serves as a barrier to some medications and hormones in the maternal blood supply. It releases insulin into the amniotic fluid for fetal usage.
Correct response: The placenta provides nourishment for the fetus. It serves as an exchange site for oxygen and carbon dioxide. It serves as a barrier to some medications and hormones in the maternal blood supply. Explanation: The placenta serves three main functions: transfer and exchange of substances such as nutrients and waste products, production of hormones, and to act as a barrier to certain substances. It does not provide a physical protection to the fetus, not does it release insulin into the amniotic fluid for fetal use.
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 increased lumbar curvature nasal congestion and swollen nasal membranes palpitations when lying on her back
Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.
A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time? "Douching will definitely keep your vagina clean." "If you prepare your own douching solution, be sure to boil the water to kill bacteria." "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." "Let's discuss this with your health care provider before you continue douching."
Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.
A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? G2 T2 P1 A0 L2 G2 T1 P1 A1 L1 G3 T0 P1 A1 L2 G3 T2 P2 A0 L1
G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; mulitple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.
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
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.
A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement? Immunologic activity is decreased during pregnancy. The level of aldosterone during pregnancy reduces production of IgG antibodies. The decreased corticosteroid activity during pregnancy ensures this will not happen. The kidneys release a hormone during pregnancy to prevent this from happening.
It is unproven why women do not reject fetal (foreign) tissue, but a substance secreted by the placenta is thought to decrease the usual immunologic response and prevent this from happening.
The nurse is assisting a primigravid on calculating the due date of her baby using Naegele's rule. The most important information provided by the mother is: the first day of the last menstrual period. the ovulation date between her periods. the date that intercourse occurred. the last day of her menstrual period.
Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date nor last day of the menstrual period is needed.
The nurse is assessing a pregnant woman on a routine prenatal visit. Which breast assessment finding will the nurse document as a normal and expected finding? hypopigmentation of the areola and nipples disappearance of superficial veins expression of colostrum in the first trimester tingling sensations and tenderness
Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery tubercles, prominence of superficial veins, development of striae, and expression of colostrum in the second and third trimesters.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placentae and placenta previa. Which statement should the nurse include in the teaching? "Placenta previa causes painful, dark red bleeding during pregnancy due to an abnormally implanted placentae that is too close to or covers the cervix; abruptio placenta is associated with bright red painless bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placentae is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the fundus; abruptio placentae is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." "Placenta previa causes painful, dark red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the fundus; abruptio placentae is associated with right red painless bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."
Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless bright red bleeding in the third trimester. Abruptio placenta is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor.
A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they, "just want to make sure that there is nothing wrong with our baby." How could the clinician best respond to this statement? "We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information." "Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee." "Prenatal screening is not usually necessary unless you are among a high-risk group." "You need to be aware that if abnormalities are detected, termination is normally required." TAKE ANOTHER QUIZ
Prenatal screening provides a useful, but incomplete, picture of fetal health; umbilical sampling and amniocentesis are common methods of screening. Fetal tissue biopsy is a rarely-used screening method, and a couple need not belong to a high-risk group to benefit from prenatal screening. Abnormalities do not usually necessitate termination.
A 24-week pregnant client calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. She may have a bleeding disorder so she needs to come back to the clinic for blood work. It is possible she is losing her mucous plug, which can cause bloody show. Some bleeding during pregnancy is not uncommon and this finding is expected.
Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucous plug occurs at the end of pregnancy, just prior to labor
The health care provider is concerned about a client's fetus having appropriate blood flow through the fetal vessels. Which diagnostic test does the nurse anticipate to confirm a diagnosis? Transabdominal ultrasound Doppler study Amniocentesis Maternal serum alpha-fetoprotein screening
The Doppler flow study is best for identification of blood flow. It places a transducer on the client's abdomen and allows the sonographer to assess blood flow through fetal vessels and in the fetal aorta, brain and heart. A transabdominal ultrasound is commonly used to determine gestational age, observe the fetus and diagnose complications of pregnancy. Amniocentesis is commonly used to identify chromosomal or genetic abnormalities. The maternal serum alpha-fetoprotein screening is used to determine neural tube defects.
The nurse is providing prenatal education to a group of pregnant teenagers. One of the group members asks how the baby develops after the first trimester. An accurate statement from the nurse about the fetal stage would be which of the following? The heartbeat can be heard No kidney function happens before birth Embryo no longer vulnerable to toxins Bones are completely ossified
The fetal stage lasts from 9 weeks to birth. All body organs and systems continue to grow and develop. At the end of the first trimester (12 weeks' gestation), some reflexes are present, kidney secretion begins, the heartbeat can be heard by Doppler, and the sex of the infant is distinguishable by outward appearance. The bones continue to ossify. The baby continues to be vulnerable to toxins during the entire pregnancy.
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.
A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination? Ensure that the client is lying down. Ensure that the client's family is present. Instruct the client to empty her bladder. Instruct the client to keep taking deep breaths.
When preparing the client for a physical examination, the nurse should instruct the client to empty her bladder; the nurse should then collect the urine sample so that it can be sent for laboratory tests to detect possibilities of a urinary tract infection. The client need not lie down, take deep breaths, or have the family present; however, it is important for the nurse to ensure that the client feels comfortable.
