Adaptive Quizzing Pregnancy, Labor, Childbirth, Postpartum- low risk

When teaching about nutrition during pregnancy, which is the change in daily caloric intake the nurse would say the pregnant woman needs? 1 A decrease of 100 calories per day 2 A decrease of 200 calories per day 3 An increase of 300 calories per day 4 An increase of 500 calories per day

An increase of 300 calories per day is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy. A decrease of 100 to 200 calories per day will not meet the metabolic demands of pregnancy and may harm the fetus. An increase of 500 calories per day is the recommended caloric increase for breast-feeding mothers.

In the second hour after the client gives birth, her uterus is firm, above the level of the umbilicus, and to the right of midline. Which nursing action is an appropriate response to this situation? 1 Having the client empty her bladder 2 Watching for signs of retained secundines 3 Massaging the uterus vigorously to prevent hemorrhage 4 Explaining to the client that this is a sign of uterine stabilization

Having the client empty her bladder

The fetus of a client in labor is found to be at +1 station. Where would the nurse locate the presenting part? 1 On the perineum 2 High in the pelvis 3 Just below the ischial spines 4 Slightly above the ischial spines

Just below the ischial spines Rationale: The term station is used to indicate the location of the presenting part. The level of the tip of the ischial spines is considered zero station. The position of the bony prominence of the fetal head is described in centimeters, minus (above the spines) or plus (below the spines). On the perineum, referred to as crowning, is designated as +5. High in the pelvis is indicated by the term floating, which means that the presenting part has not yet engaged in the pelvis. A station of -1 indicates that the head is just above the ischial spines.

A vaginal examination reveals that a client's cervix is 90% effaced and dilated to 6 cm. The fetus's head is at station 0, and the fetus is in a right occiput anterior position. The contractions are occurring every 3 to 4 minutes, are lasting 60 seconds, and are of moderate intensity. Which description is appropriate to use when reporting on the client's condition? 1 Early first stage of labor 2 Transition stage of labor 3 Beginning second stage of labor 4 Midway through first stage of labor

Midway through first stage of labor The cervix is 90% effaced and dilated 6 cm during the active phase of (or midway through) the first stage of labor. When the cervix is dilated 6 cm, the individual is beyond the early stage of labor. Transition is the last phase of the first stage of labor, which begins when the cervix is dilated 8 cm. The second stage of labor begins when the cervix is fully dilated and 100% effaced.

Which potential complication is associated with ketonuria that can occur when clients severely restrict their calorie intake during pregnancy? 1 Preterm labor 2 Placenta previa 3 Gestational diabetes 4 Hyperemesis gravidarum

Preterm labor Dietary restriction during pregnancy results in catabolism of fat stores that in turn augments the production of ketones, and ketonuria is associated with preterm labor. Ketonuria is not associated with placenta previa, gestational diabetes, or hyperemesis gravidarum.

In which location is the presenting part of the fetus when it is at 0 station? 1 Entering the vagina 2 Floating within the bony pelvis 3 At the level of the ischial spines 4 Above the level of the ischial spines

The ischial spines are used as landmarks in relation to the fetus's head because they reflect the progression of labor; 0 station indicates that the presenting part is at the ischial spines. When the head enters the vagina, it is below the ischial spines and its position is designated with positive numbers (+1 to +4). When the presenting part is floating, the fetus is at -5 station. A position above the ischial spines is designated by a minus number (-1 to -4).

A prenatal client's vaginal mucosa is noted to have a purplish discoloration. Which sign would be documented in the client's clinical record? 1 Hegar 2 Goodell 3 Chadwick 4 Braxton-Hicks

Chadwick A purplish coloration, called the Chadwick sign, results from the increased vascularity and blood vessel engorgement of the vagina. The Hegar sign is softening of the lower uterine segment. The Goodell sign is softening of the cervix. After the fourth month of pregnancy, irregular, painless uterine contractions, called Braxton-Hicks contractions, can be felt through the abdominal wall.

Which descriptor would the nurse use when explaining to a client how to time the frequency of contractions? 1 From the end of 1 contraction to the end of the next contraction 2 From the end of 1 contraction to the beginning of the next contraction 3 From the beginning of 1 contraction to the end of the next contraction 4 From the beginning of 1 contraction to the beginning of the next contraction

From the beginning of 1 contraction to the beginning of the next contraction The frequency of contractions is timed from the beginning of 1 contraction to the beginning of the next; this is the definition of 1 contraction cycle. The beginning, not the end, of a contraction is the starting point for timing the frequency of contractions. The time between the end of 1 contraction and the beginning of the next contraction is the interval between contractions. Timing from the beginning of 1 contraction to the end of the next contraction is too long a time frame and will produce inaccurate information.

Which action would the nurse take when a client's membranes rupture while her labor is being augmented with an oxytocin infusion and variable decelerations in the fetal heart rate occur? 1 Change the client's position. 2 Take the client's blood pressure. 3 Stop the client's oxytocin infusion. 4 Prepare the client for an immediate birth.

Change the client's position. Variable decelerations are usually the result of cord compression; a change of position will relieve the pressure on the cord. Variable decelerations are not related to the mother's blood pressure or to the oxytocin. Preparing the client for an immediate birth is premature; other nursing measures should be tried first.

Which direction would be given to a client with a fourth-degree perineal laceration to protect the area from additional trauma? 1 "Take sitz baths at least 3 times each day." 2 "Apply a premoistened anesthetic pad to the area." 3 "Avoid straining at stool by use of an enema." 4 "Eat a high-fiber diet with increased fluid intake."

"Eat a high-fiber diet with increased fluid intake." Fluid and fiber help promote soft stools and defecation. Promotion of defecation is a priority because a fourth-degree laceration impinges on the rectal sphincter. Constipation will further traumatize the rectum. Although sitz baths and anesthetic pads each relieve pain and promote healing, they do not prevent additional trauma. An enema would cause additional trauma to the rectum and is contraindicated.

Which is the most appropriate response when a client asks if the nurse thinks the ordered nonstress test is necessary? 1 "It's a fast, harmless procedure." 2 "You seem to have doubts about this test." 3 "This test is routinely done at this time in a pregnancy." 4 "There may be problems, and we want to reduce the risks."

"You seem to have doubts about this test." Observing that the client is having doubts encourages her to discuss her fears and anxieties. Telling the client that the test is fast, harmless, or routine cuts off communication and does not allow the client to express her fears and anxiety. The mention of risk may frighten the client and does not encourage the client to discuss the situation further.

Which laboratory test is conducted during the initial prenatal visit? Select all that apply. One, some, or all responses may be correct. 1 1-hour glucose tolerance test 2 3-hour glucose tolerance test 3 Cervical culture for Neisseria gonorrhoeae 4 Chest x-ray for a positive tuberculosis skin test (TST) 5 Group beta streptococcus (GBS) vaginal and anal cultures

Cervical culture for Neisseria gonorrhoeae During the initial prenatal visit, a cervical culture for N. gonorrhoeae is obtained. A 1-hour glucose tolerance test is completed at 24 to 28 weeks of gestation. A 3-hour glucose tolerance test is completed if a pregnant client fails the 1-hour glucose tolerance test. A chest x-ray is required after 20 weeks of gestation if the client has a positive TST. Vaginal and anal cultures for GBS are obtained at 35 to 37 weeks of gestation.

One hour after a birth the nurse palpates a client's fundus to determine whether involution is taking place. The fundus is firm, in the midline, and 2 fingerbreadths below the umbilicus. Which would the nurse do next? 1 Encourage the client to void. 2 Notify the health care provider immediately. 3 Massage the uterus and attempt to express clots. 4 Continue periodic assessments and record the findings

Continue periodic assessments and record the findings Immediately after birth the uterus is 2 cm below the umbilicus; during the first several postpartum hours the uterus will rise slowly to just above the level of the umbilicus. These findings are expected, and they should be recorded. Encouraging the client to void is unnecessary; if the bladder is full, the uterus will be higher and pushed to one side. Notifying the health care provider is unnecessary; involution is occurring as expected. Massage is used when the uterus is soft and "boggy."

At which point during a human pregnancy does the embryo become a fetus? 1 During the 8th week of the pregnancy 2 At the end of the 2nd week of pregnancy 3 When the fertilized egg becomes implanted 4 When the products of conception are seen on the ultrasound

During the 8th week of pregnancy the organ systems and other structures are developed to the extent that they take the human form; at this time the embryo becomes a fetus and remains so until birth. At the end of the 2nd week of pregnancy, the developing cells are called an embryo. At the time of implantation, the group of developing cells is called a blastocyst. The embryo can be visualized on ultrasound before it becomes a fetus.

A client who is at 20 weeks' gestation visits the prenatal clinic for the first time. Assessment reveals temperature of 98.8°F (37.1°C), pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weight of 142 lb (64.4 kg) (prepregnancy weight was 132 lb [59.9 kg]), fetal heart rate (FHR) of 140 beats per minute, urine that is negative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). Which would the nurse do after making these assessments? 1 Report the findings because the client needs immediate intervention. 2 Document the results because they are expected at 20 weeks' gestation. 3 Record the findings in the medical record because they are not within the norm but are not critical. 4 Prepare the client for an emergency admission because these findings may represent jeopardy to the client and fetus.

Document the results because they are expected at 20-weeks' gestation. Rationale All data presented are expected for a client at 20-weeks' gestation and should be documented. There is no need for immediate intervention or an emergency admission because all findings are expected.

Which statement made by a pregnant client after a prenatal class on fetal growth and development indicates the need for additional teaching? 1 "The baby is smaller if the mother smokes." 2 "The baby gets food from the amniotic fluid." 3 "The baby's oxygen is provided by the mother." 4 "The baby's umbilical cord has 2 arteries and 1 vein."

"The baby gets food from the amniotic fluid." The amniotic fluid serves as a protective environment; the fetus depends on the placenta, along with the umbilical blood vessels, to supply blood containing nutrients and oxygen. "The baby is smaller if the mother smokes," "The baby's oxygen is provided by the mother," and "The baby's umbilical cord has 2 arteries and 1 vein" are all true statements, and further teaching would not be required.

For which reason would the nurse encourage a client to void during the first stage of labor? 1 A full bladder is often injured during labor. 2 A full bladder may inhibit the progress of labor. 3 A full bladder jeopardizes the status of the fetus. 4 A full bladder predisposes the client to urinary infection.

A full bladder inhibits the progress of labor by encroaching on the uterine space and impeding the descent of the fetal head. The bladder may become atonic, but is not physically damaged during the course of labor. A full bladder may lead to prolonged labor but generally does not jeopardize fetal status as long as adequate placental perfusion continues. A full bladder during labor does not predispose the client to infection.

Which phrase describes the location of the presenting part when the fetus is at +1 station? 1 Not yet engaged 2 Entering the pelvic inlet 3 Below the ischial spines 4 Visible at the vaginal opening

Below the ischial spines A +1 station indicates that the fetal presenting part is 1 cm below the ischial spines, which are the points of engagement. Entrance of the pelvic inlet is designated as 0 station or as a negative number. The head must be at +3 to +5 to be visible at the vaginal opening.

Which information about adolescent growth and development would the nurse need to understand before discussing changes in body size to a 16-year-old adolescent at 24 weeks' gestation? 1 Adolescents generally regain their figures 2 weeks after the birth, so size is of moderate concern. 2 Adolescents are in a high-risk category, so weight gain should be limited to prevent complications. 3 Body image is very important to adolescents; therefore, pregnant teenagers are overly concerned about body size. 4 Physiological growth in adolescents is more rapid than in adults, so the gravid size is larger than that of an adult woman.

Body image is very important to adolescents; therefore, pregnant teenagers are overly concerned about body size. Because of the changes in body size, the pregnant adolescent may feel insecure as she struggles to establish her identity. There are no data to support the statement that adolescents generally regain their figures 2 weeks after the birth. The optimal weight gain for an adolescent is at the upper range for her body mass index; this will help prevent complications, so limiting weight gain does not prevent complications. Although physiological growth is rapid, the adolescent's gravid size falls within the expected parameters for pregnant women and is not larger than that of adult women.

A pregnant client asks how smoking will affect her baby. Which information about cigarette smoking will influence the nurse's response? 1 It relieves maternal tension, and the fetus responds accordingly to the reduction in stress. 2 The resulting vasoconstriction affects both fetal and maternal blood vessels. 3 Substances contained in smoke permeate through the placenta and compromise the fetus's well-being. 4 Effects are limited because fetal circulation and maternal circulation are separated by the placental barrier.

Cigarette smoking or continued exposure to secondary smoke causes both maternal and fetal vasoconstriction, resulting in fetal growth retardation and increased fetal and infant mortality. There is no clinical evidence that smoking relieves tension or that the fetus is more relaxed. Smoking causes vasoconstriction; permeability of the placenta to smoke is irrelevant. Although the fetal and maternal circulations are separate, vasoconstriction occurs in both mother and fetus.

Which action would the nurse take when external fetal uterine monitoring shows fetal heart rate (FHR) decelerations in a uniform wave shape that reflects the shape of the contraction? 1 Notify the health care provider of possible head compression. 2 Place the client in a knee-chest position to avoid cord compression. 3 Assist the client into a dorsal recumbent position to prevent compression of the vena cava. 4 Continue to monitor for return of the FHR to baseline when each contraction ends.

Continue to monitor for return of the FHR to baseline when each contraction ends. The reading noted by the nurse represents early decelerations that occur with head compression during a contraction, with the fetal heart rate (FHR) returning to baseline at the end of the contraction. Head compression and cord compression are both common occurrences during a contraction; intervention is unnecessary if the FHR returns to baseline at the end of the contraction. The dorsal recumbent position will increase pressure on the vena cava and is contraindicated.

Which factor accounts for the greatest portion of weight gain during pregnancy? 1 Fetal growth 2 Fluid retention 3 Metabolic alterations 4 Increased blood volume

Fetal growth Weight gain during pregnancy averages 25 to 35 lb (11.3-15.9 kg). Of this amount, the fetus accounts for 7 to 8 lb (3.2-3.6 kg), or approximately 30%. Fluid retention accounts for 20% to 25% of weight gain. Metabolic alterations do not cause weight gain. Increased blood volume accounts for 12% to 16% of weight gain.

Early in the ninth month of pregnancy a client experiences painless vaginal bleeding secondary to a placenta previa. Which intervention would the client's plan of care include? 1 Giving vitamin K to promote clotting 2 Performing a rectal examination to assess cervical dilation 3 Administering an enema to prevent contamination during birth 4 Placing the client in the semi-Fowler position to increase cervical pressure

Placing the client in the semi-Fowler position to increase cervical pressure Placing the client in the semi-Fowler position forces the heavy uterus to put pressure on the blood vessels at the site of the separating placenta, controlling bleeding to some extent. There is no indication that the clotting mechanism is disturbed. Performing a rectal examination is contraindicated with placenta previa; it may further dislodge the placenta. Enemas are contraindicated in any client admitted with vaginal bleeding.

Which complication is the pregnant client at risk for related to the dilation of renal pelves and ureters? 1 Frequent urination 2 Urinary tract infection 3 Glomerular filtration rate decreases 4 Increased urinary excretion of protein and albumin

Urinary tract infection Dilation of renal pelves and ureters during pregnancy increases the risk of urinary tract infections. Frequent urination is an expected occurrence during pregnancy due to increased bladder sensitivity during early pregnancy and due to bladder compression by the uterus during later pregnancy.By the end of the first trimester the glomerular filtration rate increases by 50% and remains elevated throughout pregnancy. During normal pregnancy there is an increased urinary excretion of protein and albumin, most notably after 20 weeks' gestation.