Susan Wilson 1 Hesi Case study OB

Which of the following is considered a positive sign of pregnancy that could be present at this point in Susan's pregnancy (eight weeks gestation)? A. Fetal cardiac activity or body movement noted on ultrasound B. Palpation of fetal movements by an examiner C. Ballottement noted on vaginal examination D. Uterine souffle auscultated with Doppler

A. Fetal cardiac activity or body movement noted on ultrasound Ultrasonography is a noninvasive technique that can detect the presence of fetal cardiac activity or body movement as early as 6-7 weeks gestation. Detection of fetal cardiac activity or movement by ultrasound would be a positive sign of pregnancy. At eight weeks gestation, fetal activity could be demonstrated on ultrasound.

Which of the following information should be communicated to Susan regarding the benefits of smoking cessation at this point in her pregnancy? Select all that apply (there are 3 correct answers). A. It will decrease the risk of intrauterine growth restriction (IUGR) and giving birth to a low-birth-weight infant B. It will increase the oxygen supply to the fetus C. It will reduce the risk of preterm labor and premature rupture of membranes D. It will reduce the risk of neural tube defects

A. It will decrease the risk of intrauterine growth restriction (IUGR) and giving birth to a low-birth-weight infant B. It will increase the oxygen supply to the fetus C. It will reduce the risk of preterm labor and premature rupture of membranes Maternal smoking interferes with diffusion of nutrients and oxygen to the developing fetus and is associated with low birth weight infants, secondary to the vasoconstrictive effect of smoking on placental vessels Oxygen supply to the fetus is reduced with maternal smoking for a number of reasons. Smoking causes vasoconstriction of placental vessels, interfering with diffusion of nutrients and oxygen to the developing fetus. Also, maternal hemoglobin has a greater affinity for carbon monoxide (found in cigarette smoke) than for oxygen. Thus, oxygen levels are lower in women who smoke. In turn, less oxygen is available to the developing fetus. There is a recognized association between maternal smoking and the incidence of preterm labor and premature rupture of membranes. These may be related to the decreased placental perfusion associated with smoking.

You teach Susan to expect which of the following breast changes as her pregnancy progresses? Select all that apply (there are 4 correct answers). A. Nipples will darken and become more erectile B. Blood vessels will become visible at the skin surface C. Striae gravidarum may appear D. Stretching may cause minor ulcerations to appear E. Liquid may be expressed from the nipples as pregnancy advances

A. Nipples will darken and become more erectile B. Blood vessels will become visible at the skin surface C. Striae gravidarum may appear E. Liquid may be expressed from the nipples as pregnancy advances Nipples darken during pregnancy due to the influence of the hormone, melonocyte stimulating hormone (MSH). Increased estrogen levels cause increased vascularity of the breasts, which may cause the nipples to be more erectile. Blood vessels in the breasts become more visible during pregnancy due to increased blood flow. Primigravidas may have more obvious venous congestion. Striae gravidarum, or stretch marks, may appear along the outer aspects of the breasts as enlargement occurs. During the first trimester, a precolostrum secretion may be present. Colostrum, the precursor to milk, is present in the breasts as early as the third month of gestation. Colostrum usually cannot be expressed until 16 weeks or later, but sometimes can be expressed sooner in women who have breastfed in the recent past. These breast secretions may be clear or creamy yellow-white in color.

Susan asks you, "How much is too much vomiting?" You advise Susan to call the clinic if she experiences which of the following? Select all that apply (there are 3 correct answers). A. She urinates less frequently than usual, and her urine becomes darker in color B. Her palms become reddened and itch C. She vomits blood or her throat becomes sore from vomiting D. She vomits everything she eats or drinks in a 24-hour period

A. She urinates less frequently than usual, and her urine becomes darker in color C. She vomits blood or her throat becomes sore from vomiting D. She vomits everything she eats or drinks in a 24-hour period With excessive vomiting, Susan could become dehydrated. With dehydration, the body would retain fluid as a compensatory measure, and urine output would decrease. Urine would also become more concentrated, and darker in color. It is appropriate that Susan be advised to report signs of dehydration. Vomiting blood and a very sore throat are significant. They could be the result of a tear in the mucosa of the esophagus, secondary to retching (dry heaves). Susan should seek medical attention immediately if these occur. A client who is unable to keep food or drink down for 24 hours, or is unable to stop vomiting, should be seen by her healthcare provider as soon as possible. Antiemetic medication and rehydration might be needed.

Theorists have identified three developmental tasks to be accomplished as the mother-child relationship evolves throughout pregnancy. You know that during this first trimester, Susan's developmental task is to: A. accept the biologic fact of pregnancy B. accept the fetus as distinct and separate from herself C. prepare realistically for parenting D. acknowledge that she will be a good mother

A. accept the biologic fact of pregnancy Acceptance of the biologic fact of pregnancy characterizes the first trimester. The pregnant woman needs to acknowledge "I am pregnant" as she accepts the immediate reality of the pregnancy itself.

You also review Susan's lab work, recalling that pregnancy tests on urine or blood are determined to be positive based on the presence of a particular hormone. This biologic marker of pregnancy is: A. human chorionic gonadotropin B. estrogen C. progesterone D. follicle-stimulating hormone

A. human chorionic gonadotropin Human chorionic gonadotropin (HCG), produced by the trophoblast cells of the placenta soon after implantation of a fertilized ovum, is a biologic marker of pregnancy. It can be detected in maternal serum and urine as early as six days after conception, depending on the test performed. It reaches its maximum level in 50-70 days. The presence of HCG in Susan's blood is considered a probable sign of pregnancy. Positive pregnancy tests can also occur if the client has certain tumors which produce HCG. Progesterone is not a biological marker of pregnancy, but increases in progesterone levels are critical for the maintenance of a pregnancy.

Susan knows to notify her care provider immediately if she suspects her membranes have ruptured. This is important due to the increased risk of ___________________ with ruptured membranes.

Infection

In counseling Susan about sexual activity during pregnancy, which of the following comments would be best? A. "You are very fortunate. Most women don't want anything to do with sex during pregnancy." B. "It is common for sexual desire to vary during pregnancy." C. "It's great that you enjoy sex now. You will need to abstain from sex after 36 weeks." D. "Be very careful about sexual relations during pregnancy. Orgasm can cause preterm labor."

B. "It is common for sexual desire to vary during pregnancy." This comment would be appropriate. Sexual desire during pregnancy is variable. However, during the first trimester, when the pregnant woman is fatigued and experiencing nausea, sexual desire may diminish. The second trimester may bring an increased libido, with an improved sense of well-being. In the third trimester, sexual desire may wane, as physical bulkiness and fatigue become major concerns. In general, however, sexual desire during pregnancy is highly individual.

What measures could you suggest to Susan to help decrease or alleviate the annoying discomfort of heartburn? Select all that apply (there are 3 correct answers). A. Lie down for 15-30 minutes immediately after eating B. Avoid fatty and gas-producing foods C. Maintain good posture D. Take any over-the-counter liquid antacid after meals E. Eat six small meals a day instead of three large meals

B. Avoid fatty and gas-producing foods C. Maintain good posture E. Eat six small meals a day instead of three large meals Fatty and gas-producing foods are known to contribute to heartburn. It would be appropriate to recommend to Susan that they be avoided. Maintaining an erect, non-stooped posture would promote emptying of the stomach and prevent gastroesophageal reflux, which could contribute to heartburn. With advancing pregnancy, the stomach is displaced upward and compressed by the uterus. Stomach capacity is thus decreased. Eating six small meals a day instead of three large ones should help prevent heartburn associated with overfilling of the stomach and subsequent gastroesophageal reflux.

Which of the following suggestions are appropriately made to Susan to help alleviate her symptoms? Select all that apply (there are 2 correct answers). A. Eat a large breakfast Eating a large meal in the morning would distend Susan's stomach and increase the likelihood of nausea and vomiting. Eating a large meal in the morning should be avoided. B. Eat small frequent meals throughout the day Correct Small, frequent meals are recommended for the pregnant woman who is experiencing nausea and vomiting. An empty stomach or one that is overloaded would increase the likelihood of nausea and vomiting. C. Eat dry toast or crackers before getting out of bed Correct Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the morning, often helps to prevent the nausea associated with "morning sickness." If nausea is present before rising, it is advisable to remain in bed after eating a dry carbohydrate until the feeling of nausea subsides. D. Drink plenty of fluids when nausea occurs Increasing fluids would not be useful in alleviating nausea. Fluids can distend the stomach, increasing nausea. Small amounts of fluid, alternated hourly with dry carbohydrates, may be helpful in alleviating nausea.

B. Eat small frequent meals throughout the day C. Eat dry toast or crackers before getting out of bed Small, frequent meals are recommended for the pregnant woman who is experiencing nausea and vomiting. An empty stomach or one that is overloaded would increase the likelihood of nausea and vomiting. Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the morning, often helps to prevent the nausea associated with "morning sickness." If nausea is present before rising, it is advisable to remain in bed after eating a dry carbohydrate until the feeling of nausea subsides.

In formulating a plan of care based on Susan's symptoms of nausea and vomiting, which of the following is determined to be an appropriate nursing diagnosis? A. Risk for Injury related to malnutrition B. Imbalanced Nutrition: Less than Body Requirements related to nausea and vomiting C. Imbalanced Nutrition: Less than Body Requirements related to inadequate knowledge of good nutrition D. Deficient Fluid Volume related to nausea and vomiting

B. Imbalanced Nutrition: Less than Body Requirements related to nausea and vomiting Susan's diet is lacking in caloric intake, protein, and calcium, substances deemed especially necessary during pregnancy. Because Susan is experiencing nausea and vomiting, she is likely to be eating less, and may often be "losing" what she eats. Imbalanced Nutrition: Less than Body Requirements related to nausea and vomiting is an appropriate nursing diagnosis for Susan.

Susan mentions, "I've heard that it is normal to be a little anemic during pregnancy." You understand that Susan is probably referring to the "physiologic anemia of pregnancy." This is related to: A. a decrease in red blood cell production B. an increase in plasma volume in excess of an increase in red blood cells C. hemolysis of maternal red blood cells by fetal antibodies that cross the placenta

B. an increase in plasma volume in excess of an increase in red blood cells During pregnancy, Susan's plasma volume will increase by 50%, but her red blood cells will increase only by 18-30%, depending on whether or not she takes iron supplements. This results in hemodilution, with a corresponding decrease in normal hemoglobin and hematocrit values. This is often referred to as the "physiologic anemia of pregnancy" or the "hemodilution of pregnancy."

After analyzing Susan's responses, you explain that feelings of ambivalence about pregnancy: A. are normal for fathers, but not for mothers B. are common among expectant mothers and fathers C. suggest an increased risk for future child abuse

B. are common among expectant mothers and fathers Ambivalence is a common response to pregnancy for both parents, even when the pregnancy is desired. Such feelings are usually resolved as the second trimester begins, but may persist throughout pregnancy.

You discuss the signs of "true labor" with Susan. You recognize that your teaching has been effective when Susan describes "true labor" contractions as: Select all that apply (there are 2 correct answers). A. contractions that begin in the abdomen and radiate to the back B. contractions that intensify with walking or position change C. contractions that become more regular as time goes by

B. contractions that intensify with walking or position change C. contractions that become more regular as time goes by Contractions that become more intense with walking or position change are typically associated with true labor. Contractions that become more regular with time and increase in intensify, frequency, and duration are typically associated with true labor.

You advise Susan to return to the clinic regularly for prenatal visits. Provided there are no complications, she can anticipate visits to occur: A. every month throughout pregnancy B. every four weeks until 28 weeks, every two weeks until 36 weeks, then weekly until delivery C. every six weeks until 36 weeks, then weekly until delivery D. every four weeks until 24 weeks, every two weeks until 32 weeks, then weekly until delivery

B. every four weeks until 28 weeks, every two weeks until 36 weeks, then weekly until delivery Traditionally, monthly prenatal visits (every four weeks) are recommended during the first 28 weeks of pregnancy. Visits increase to every two weeks from the 28th to the 36th week, and then every week from 37 weeks until delivery. Visits increase because the risk of complications associated with pregnancy increases as pregnancy advances.

During Susan's last trimester, she and John attend childbirth preparation classes. These classes are intended to teach expectant parents that: Select all that apply (there are 3 correct answers). A. analgesics will not be needed during labor and delivery if breathing and relaxation techniques are used B. fear, tension, and pain during labor and delivery can be reduced and dealt with effectively C. understanding of the labor and delivery process can enhance participation and control during labor and delivery D. perception of painful uterine contractions during labor and delivery can be altered through relaxation and breathing

B. fear, tension, and pain during labor and delivery can be reduced and dealt with effectively C. understanding of the labor and delivery process can enhance participation and control during labor and delivery D. perception of painful uterine contractions during labor and delivery can be altered through relaxation and breathing Fear, tension, and pain during labor and delivery can usually be reduced or controlled with effective use of relaxation and breathing techniques and analgesics, if needed. Understanding the labor and delivery process enables mothers (and coaches) to participate more effectively in measures designed to facilitate the natural course of labor and delivery. Informed mothers (and coaches) also tend to participate more cooperatively with staff members assisting with labor and delivery. Perception of painful uterine contractions can be altered with effective use of relaxation and breathing techniques. Distraction is also an important component of this process.

You explain that the contractions she describes are common during late pregnancy and function to increase blood flow to the uterus. They are referred to as ____________________ contractions.

Braxton Hicks

You instruct Susan about taking her daily iron supplement. Which of the following statements should be included in the teaching session? Select all that apply (there are 2 correct answers). A. "Take the iron supplement first thing in the morning to avoid gastrointestinal discomfort." B. "Drink a glass of milk along with your iron supplement." C. "Increase your intake of citrus fruits and juices." D. "If tolerated, take the iron supplement on an empty stomach."

C. "Increase your intake of citrus fruits and juices." D. "If tolerated, take the iron supplement on an empty stomach." Iron absorption is enhanced when intake of Vitamin C is increased. Citrus fruits and juices, tomatoes, melons, and strawberries are all high in Vitamin C and should be encouraged when iron supplements are prescribed. Absorption is optimal when an iron supplement is taken on an empty stomach. Pregnant women taking iron supplements should be encouraged to take supplements on an empty stomach, provided gastrointestinal distress is not a problem.

You advise Susan that an appropriate weight gain during pregnancy based on her weight and height would be: A. 15 pounds (7 kg) B. 15 - 25 pounds (7 - 11.5 kg) C. 25 - 35 pounds (11.5 - 16 kg) D. 28 - 40 pounds (12.5 - 18 kg)

C. 25 - 35 pounds (11.5 - 16 kg) An appropriate weight gain during pregnancy for Susan, who is normal weight for her height, would be 25-35 pounds (11.5 - 16 kg). For a woman who is underweight, an appropriate weight gain would be 28-40 pounds (12.5 - 18 kg). For a woman determined to be overweight, an appropriate weight gain would be 15-25 pounds (7 - 11.5 kg). For a woman who is obese, an appropriate weight gain during pregnancy would be at least 15 pounds (7 kg).

Susan has noticed some darkening of her face in the shape of a "mask." You advise her that this is normal and record it as ___________________________

CHLOASMA

During Susan's pelvic examination, a bluish discoloration of the cervix and vaginal mucosa is observed. This is a sign of pregnancy and is documented as _____________.

Chadwick's sign

Susan is curious about when she should gain all this weight. Your response is based on the concept that: A. primigravidas should gain two pounds (0.9 kg) per week throughout pregnancy B. most women gain more than half their weight by the end of the first trimester C. amount of weight gain is more critical than the pattern of weight gain D. 2-5 pounds (0.9 - 2.3 kg) should be gained in the first trimester, then an average of one pound per week thereafter

D. 2-5 pounds (0.9 - 2.3 kg) should be gained in the first trimester, then an average of one pound per week thereafter The recommended pattern of weight gain during pregnancy is 2-5 pounds (0.9 - 2.3 kg) during the first trimester, and an average of one pound (0.5 kg) per week during the second and third trimesters. The developing fetus increases in size more dramatically during the second and third trimesters. Poor weight gain during the first trimester is associated with an increased risk of a small-for-gestational age (SGA) infant. Poor weight gain in the last half of pregnancy is associated with increased risk for preterm delivery.

Susan's current vital signs are BP 110/70, P 80. Comparing them to baseline vital signs (BP 118/74, P 68) recorded during Susan's first visit, which of the following do you determine? A. Susan's vital signs are considered normal B. Susan's vital signs are considered abnormal

Susan's vital signs are considered normal During pregnancy, increases in blood volume, cardiac A. output, and basal metabolic rate cause changes in vital signs. Normal increases in heart rate up to 10-15 beats per minute can be expected during the second trimester. Blood pressure usually remains at prepregnancy levels during the first trimester. During the second trimester, BP decreases by 5-10 mm Hg, probably due to peripheral vasodilation caused by hormones of pregnancy. In the third trimester, blood pressure should approximate readings from the first trimester. Slight cardiac hypertrophy and grade II systolic ejection murmurs are also common, due to increases in blood volume and cardiac output.

These assessments are done to detect the onset of the complication of pregnancy called __________________________.

gestational hypertension

You question Susan about whether or not she has had any abnormal vaginal discharge or itching. During pregnancy, women are more prone to develop vaginal yeast infections due to a/an __________________ in vaginal pH.

increase

Susan inquires, "Is this what my mother calls "the baby dropping?" You acknowledge her mother's information, and tell Susan that this event is called ___________________________

lightening

You know that this practice of consuming non-food substances, common to some cultures, is called ________________

pica

You tell Susan that this "fluttering" is probably fetal movement. This first recognition of fetal movements by the mother is called _____________________

quickening