411 Chapter 12

The client's pregnancy screening test shows that the maternal serum alpha-fetoprotein (MS-AFP) level is high. Which information should the nurse provide the client upon this finding?

"A high level of MS-AFP is associated with neural tube defects. We will schedule you for another type of test to determine if your baby has a neural tube defect."

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."

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy?

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy."

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?

"The gloves they provide irritate my hands, so I don't use them."

When providing preconception care to a client, which instruction would be most important for the nurse to provide about medications during pregnancy?

"You need to talk with your provider about using medications."

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply.

Do not lie down immediately after eating. Do not eat fried, fatty foods. Eat five to six small meals per day.

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 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.

he nurse is assisting a pregnant client who has just underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results?

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

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?

Two previous pregnancies, two live births, and currently pregnant

a client in her 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

_______ involved a trans abdominal perforation of the amniotic sac to obtain a sample of amniotic fluid for analysis

amniocentesis

a pregnant client has come to a clinic for a pelvic exam. what assessments should a nurse perform when examining external genitalia

any infection due to hematoma, varicosities, and inflammation

A nurse at the health care facility assesses a client at 20 weeks' 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 level of the umbilicus

a pregnant client in her 12th week of gestation has come to a health care center for a physical examination of her abdomen. where should the nurse palpate for the funds in this client

at the symphysis pubis

what are the roles of a nurse with regard to providing counseling and education to the client at a prenatal visit

counseling and educating the pregnant client and her partner.

A _____________ is a laywoman trained to provide women and their families with encouragement, emotional, and physical support, and information through late pregnancy, labor, and birth

doula

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

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

it identifies abnormal cervical cells

The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation?

multiple fetal pregnancy

the basis for ________ test is that the normal fetus produced characteristic fetal heart rate patterns in response to fetal movements

non stress

A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate?

serum iron level

a client in her third trimester of pregnancy wishes to use the method of feeding formula to her baby. what instruction should the nurse provide

serve the formula at room temperature

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage?

stretching and breathing exercises such as yoga

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

discuss the priority assessment by the nurse during a clients initial prenatal visit

1. screen for factors that place the client and her fetus at risk 2. educate the client about changes that will after her life

At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?

"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."

During the initial history and physical of a 30-year-old primipara client, the nurse has identified some teratogens the fetus is being exposed to at this phase of the pregnancy. Which lifestyle data could result in teratogenic exposure to the fetus? Select all that apply.

1. smoking 2 packs of cigarettes a day 2.snorting cocaine once or twice a month 3. drinking alcoholic beverage 3 times a week

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-taking process

1. to prepare a plan of care that suits the clients lifestyle 2. to develop a trusting relationship with the client 3. to prepare a plan of care for the pregnancy

A hospitalized client with hyperemesis gravidarium has been tolerating small amounts of clear fluids for the past 6 hours. What is the next step in the plan of care?

Add small quantities of dry toast every 2 to 3 hours.

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.

A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply.

Limit consumption of food before bedtime. Sleep in a semi-Fowler position. Avoid overeating.

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.

A nurse working in a correctional facility is monitoring a group of pregnant inmates. Which interventions might be necessary to improve the health of these incarcerated pregnant women? Select all that apply.

Provide prenatal vitamins Ensure frequent hydration Recommend activity restrictions Coordination of care with off-site providers Provide extra food and exclude unpasteurized items

A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant woman. What does the nurse explain is the main difference when an incarcerated client comes to the clinic?

There will be correction officers with the woman throughout her appointment.

The nurse receives a call from a concerned client, who is 39 weeks' gestation, indicating the woman has "blood-tinged mucus seeping from the vagina." What does the nurse understand about this?

This is known as "bloody show" and is a normal finding at this time.

ultrasonography

acts as a guide for the need for invasive intrauterine tests and used to monitor fetal growth and placental location

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

baseline data is collected

A nurse is conducting a class with group of pregnant women who are all in their first trimester of pregnancy. During the class, the women are discussing the various discomforts that they are experiencing. The nurse would expect to hear reports about which discomforts? Select all that apply.

breast tenderness urinary frequency nausea

contraction stress test

determines the fetal heart rate response under stress, such as during contractions

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

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?

instruct the client to empty her bladder

_________ is a woman who has given birth once after a pregnancy of at least 20 weeks

primipara

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

a nurse caring for a client in labor has asked her to perform lamaze breathing techniques to avoid pain. which should the nurse keep in mind to promote effective lamaze-method breathing

remain quiet during clients period of imagery

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 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 exam

instruct the client to empty her bladder

An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?

intimate partner violence

doppler flow studies

with the help of the ultrasound, this test is used to identify abnormalities in diastolic flow within the umbilical vessels

After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client makes which statement?

"I'll sit comfortably in a recliner or lie on my side when I do the counts."

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."

what are the key areas in which the nurse should include in preconception care

1. immunization status 2. underlying medical conditions, such as cardiovascular or respiratory problems or genetic disorders. 3. sexuality and sexual practices 4. Nutrition 5. Lifestyle etc

a pregnant client has come to a health care facility for a physical examination. which assessments should a nurse perform when doing a physical examination of the head and neck

1. previous injuries and sequelae 2. limitations in range of motion 3. thyroid gland enlargement

A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?

April 27th

bluish coloration of the cervix and vaginal mucosa is known as __________ sign

Chadwick

A woman reports that her last menstrual period (LMP) occurred February 1, 2017. Using the Naegele rule, what would be her estimated date of delivery (EDD)?

November 8, 2017

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

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 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 clients discomfort

avoid consumption of caffeinated drinks

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

What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?

ask her to describe her intake for the last 24 hours

a pregnant clients last menstrual period was March 10th. Using Naegele's rule, the nurse estimates the date of birth to be

december 17

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

nuchal translucency screening (ultrasound)

conducted between 11 and 14 weeks, this test allows for earlier detection and diagnosis of some fetal chromosomes and structural abnormalities

At 34 weeks' gestation a client is diagnosed with preeclampsia and sent home on bed rest. The nurse teaches the client to contact the provider immediately if she experiences which change?

decreased fetal movement

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?

deficient knowledge

A common report during pregnancy is heartburn. What should the nurse recommend to decrease the discomfort of heartburn?

eat small, frequent meals

a client in her second trimester arrives at a health care facility for a follow-up visit. during the exam, the client reports constipation. which instruction should the nurse offer to help alleviate constipation

ensure adequate hydration and bulk in the diet

in a pregnant woman, darker pigmentation of the nipple and areola develops, along with enlargement of _________ glands in the breast

montgomery

Which information is most important in order to decrease the risk of complications if the client decides to work until her due date?

frequent rest periods

___________ height is the distance (in cm) measured with a tape measure from the top of the pubic bone to the top of the uterus while the client is lying on her back with her knees slightly flexed

fundal

______ are varicosities of there rectum which occur as a result of progesterone-induced vasodilation and from pressure the enlarged uterus on the lower intestine and rectum

hemorrhoids

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

alpha-fetoprotein is a substance produced by the fetal _______ between weeks 13 and 20 of gestations

liver

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?

nausea and vomiting

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological challenges

what is the role of a nurse in preconception care to ensure a positive impact on pregnancy

nurses can enter into a collaborative partnership with a woman and her partner, enabling them to examine their own health and its influence on the health of their future baby

percutaneous umbilical blood sampling

permits the collection of a blood specimen directly from the fetal circulation for rapid chromosomal analysis.

____________ is the craving for nonfood substances such as clay, cornstarch, laundry, detergent, baking soda, soap, paint chips, dirt, ice, or wax

pica

The police have brought a young female to the emergency department after they raided a "crack" house and found this female passed out and bleeding from her "bottom." This female is pregnant and is likely bleeding related to which complication of cocaine use during pregnancy? Select all that apply.

premature dislodgement of the placenta spontaneous miscarriage

A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client?

pressure on the intestine by growing fetus

Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?

severe dehydration resulting in hypoperfusion of the placenta

During initial examination in the labor room, the nurse notes a large amount of white, bubbly discharge around the vaginal walls that has a foul smell. The nurse suspects the woman has which type of sexually transmitted infection?

trichomoniasis

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

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 physician

vaginal bleeding

The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide?

verify that desired outcomes for identified goals have been met

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?

20 cm

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.

The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?

amniocentesis

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