ANTEPARTUM 2

4.Striae gravidarum Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. After birth they usually fade, although they never disappear completely. Options 1, 2, and 3 are incorrect. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, browning hyperpigmentation of the skin over the cheeks, nose, and forehead and is especially noticed in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasias, or vascular "spiders," are tiny star-shaped or branch-shaped, slightly raised, and pulsating end arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. The spiders usually disappear after delivery.

A clinic nurse is explaining the changes in the integumentary system that occur during pregnancy to a client and should tell the client that which change may persist after she gives birth? 1.Epulis 2.Chloasma 3.Telangiectasia 4.Striae gravidarum

3."It is the presence of tissue outside the uterus that resembles the endometrium Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in both structure and function. The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Primary dysmenorrhea refers to menstrual pain without identified pathology. Mittelschmerz refers to pelvic pain that occurs midway between menstrual periods, and amenorrhea is the cessation of menstruation for at least three cycles or 6 months in a woman who has an established a pattern of menstruation. Amenorrhea can be caused by a variety of factors.

The nurse is caring for a client with a diagnosis of endometriosis. The client asks the nurse to describe this condition. What is the best response by the nurse? 1."It causes the cessation of menstruation." 2."It is pain that occurs during ovulation." 3."It is the presence of tissue outside the uterus that resembles the endometrium." 4."It is also known as primary dysmenorrhea and causes lower abdominal discomfort."

3.13 to 16 By the end of the twelfth week of gestation, the fetal gender can be determined by the appearance of the external genitalia on ultrasound; therefore the other options are incorrect.

The nurse is collecting data from a client during the first prenatal visit. The client is anxious to know the gender of the fetus and asks the nurse when she will be able to know. The nurse should respond to the client knowing that the gender of the fetus is determined by which weeks? 1.6 to 8 2.8 to 10 3.13 to 16 4.20 to 22

5.The fetus is approximately 42 to 48 cm long. 6.The lecithin-sphingomyelin (L/S) ratio is greater than 2:1 At gestational week 36, the fetus weighs 2500 g and is approximately 42 to 48 cm long. The skin is pink and the body is rounded. Lanugo is disappearing, and the L/S ratio is greater than 2:1. At gestational week 8, the eyelids begin to fuse. The fetal heart begins to beat at week 5. The fetal skin is transparent at week 16. At 28 weeks of gestation, the fetus weighs approximately 1200 g.

The nurse is reviewing fetal development with a client who is at 36 weeks gestation. Which statements describe the characteristics that develop in a fetus at this time? Select all that apply. 1.Eyelids begin to fuse. 2.Fetal heart begins to beat. 3.The fetal skin is transparent. 4.The fetus weighs approximately 1200 g. 5.The fetus is approximately 42 to 48 cm long. 6.The lecithin-sphingomyelin (L/S) ratio is greater than 2:1

2."I need to lie flat on my back to perform the procedure." The client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava (supine hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. The client records the number of movements felt during a specified time period. The client needs to notify her health care provider if she feels fewer than 10 kicks over two, 2-hour intervals or as instructed by her HCP.

The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instructions? 1."I will record the number of movements or kicks." 2."I need to lie flat on my back to perform the procedure." 3."If I count fewer than 10 kicks in a 2-hour period I should count the kicks again over the next 2 hours." 4."I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks."

4.Green leafy vegetables Sources of folic acid include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Pork, cheese, and chicken are not high in folic acid. Pork is a good source of thiamine. Cheese is a dairy product and is high in calcium. Chicken is a good source of protein.

The nurse in the prenatal clinic is providing nutritional counseling to a pregnant client. The nurse instructs the client to increase the intake of folic acid and tells the client that which food item is highest in folic acid? 1.Pork 2.Cheese 3.Chicken 4.Green leafy vegetables

1.Vaginal bleeding 3.Excessive nausea and vomiting 4.Larger-than-normal uterus for gestational age 5.Elevated levels of human chorionic gonadotropin (hCG) The most common signs and symptoms of gestational trophoblastic disease (hydatidiform mole) include vaginal bleeding, excessive nausea and vomiting, larger-than-normal uterus for gestational age, elevated levels of hCG, failure to detect fetal heart activity even with sensitive instruments, and early development of gestational hypertension. Fetal activity would not be noted.

The nurse is assessing a client with a diagnosis of gestational trophoblastic disease (hydatidiform mole). The nurse understands that which findings are associated with this condition? Select all that apply. 1.Vaginal bleeding 2.Excessive fetal activity 3.Excessive nausea and vomiting 4.Larger-than-normal uterus for gestational age 5.Elevated levels of human chorionic gonadotropin (hCG)

2.Uterine tenderness Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa.

The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? 1.Soft abdomen 2.Uterine tenderness 3.Absence of abdominal pain 4.Painless, bright red vaginal bleeding

1."I will need to increase my insulin dosage during the first 3 months of pregnancy." Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy.

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? 1."I will need to increase my insulin dosage during the first 3 months of pregnancy." 2."My insulin dose will likely need to be increased during the second and third trimesters." 3."Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." 4."My insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding."

4."Your titer supports your immunity to rubella, and it is safe for your toddler to receive the vaccine at this time." All pregnant women should be screened for prior rubella exposure during pregnancy. A positive maternal titer further indicates that a significant antibody titer has developed in response to a prior exposure to rubella. All children of pregnant women should receive their immunizations according to schedule. Additionally, no definitive evidence suggests that the rubella vaccine virus is transmitted from client to client.

The nurse is reviewing the results of the rubella screening (titer) with a pregnant client. The test results are positive, and the mother asks if it is safe for her toddler to receive the vaccine. What is the nurse's best response? 1."Most children do not receive the vaccine until they are 5 years of age." 2."You are still susceptible to rubella, so your toddler should receive the vaccine." 3."It is not advised for children of pregnant women to be vaccinated during their mother's pregnancy." 4."Your titer supports your immunity to rubella, and it is safe for your toddler to receive the vaccine at this time."

4.Human chorionic gonadotropin (hCG)

A client reports to the health care clinic and says that it has been 6 weeks since her last menstrual period. The nurse performs a pregnancy test and should expect to note the presence of which hormone in the blood test results if the client is pregnant? 1.Estrogen 2.Progesterone 3.Follicle-stimulating hormone (FSH) 4.Human chorionic gonadotropin (hCG)

2."Breast-feeding is allowed after the baby has been vaccinated with immune globulin." Although HBV is transmitted in breast milk, after immune globulin has been administered to the newborn, the woman may breast-feed without risk to the newborn. The remaining options are incorrect responses.

A pregnant woman tests positive for the hepatitis B virus (HBV). The woman asks the nurse if she will be able to breast-feed the baby as planned after delivery. Which response by the nurse is most appropriate? 1."You will not be able to breast-feed the baby until 6 months after delivery." 2."Breast-feeding is allowed after the baby has been vaccinated with immune globulin." 3."Breast-feeding is not advised, and you should seriously consider bottle-feeding the baby." 4."Breast-feeding is not a problem, and you will be able to breast-feed immediately after delivery."

1.Presence of cats in the home Toxoplasmosis is a systemic (and usually asymptomatic) illness caused by a protozoan parasite. Approximately one third of all women in the United States have positive antibody titers for toxoplasmosis, thus confirming prior exposure. Humans acquire the infection by consuming inadequately cooked meat, eggs, or milk; by ingesting or inhaling the oocyst stage excreted in feline feces or contaminated soil; or from receiving contaminated blood products. Other than transplacental infection, this disease is rarely transmitted from human to human. During pregnancy, the parasite may be transmitted across the placenta and cause severe infection in the developing embryo or fetus. The other options are questions unrelated to toxoplasmosis.

The nurse is conducting a routine screening to detect a client's risk for toxoplasmosis parasite infection during pregnancy. Which factor should the nurse ask the client about to determine this risk? 1.Presence of cats in the home 2.Number of sexual partners during pregnancy 3.Exposure to children with rashes or gastrointestinal symptoms 4.History of high fevers or unusual rashes during the first 6 weeks of pregnancy

2. The client has a history of cardiac disease Preterm labor occurs after the twentieth week but before the thirty-seventh week of gestation. Several factors are associated with preterm labor, including a history of medical conditions, present and past obstetric problems, social and environmental factors, and substance abuse. Other risk factors include a multifetal pregnancy, which contributes to overdistention of the uterus; anemia, which decreases oxygen supply to the uterus; and age younger than 18 years or first pregnancy at age older than 40 years.

The nurse is performing an initial assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor? 1.The client is a 35-year-old primigravida 2.The client has a history of cardiac disease 3.The client's hemoglobin level is 13.5 g/dL 4.The client is a 20-year-old primigravida of average weight and height

1.The client's last baby weighed 10 pounds at birth Known risk factors that increase the risk of developing gestational diabetes include obesity (more than approximately 198 pounds, depending on height), chronic hypertension, family history of diabetes mellitus, previous birth of a large infant (greater than 4000 g), and gestational diabetes in a previous pregnancy. Options 2, 3, and 4 are not risk factors associated with the development of gestational diabetes.

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy? 1.The client's last baby weighed 10 pounds at birth. 2.The client's previous deliveries were by cesarean birth. 3.The client has a family history of cardiovascular disease. 4.The client is 5 feet 3 inches in height and weighs 165 pounds.

2.Obtain equipment for a manual pelvic examination. Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia

the maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? 1.Prepare the client for an ultrasound. 2.Obtain equipment for a manual pelvic examination. 3.Prepare to draw a hemoglobin and hematocrit blood sample. 4.Obtain equipment for external electronic fetal heart rate monitoring.

2.Drink 8 glasses of water per day. The nurse should instruct the client to drink at least 8 to 10 (8-oz) glasses of fluid each day, of which 4 to 6 glasses are water, and to consume a diet that includes fiber to prevent constipation. The client should not take stool softeners, laxatives, mineral oil, other medications, or enemas without first consulting with the health care provider or nurse-midwife.

the nurse is developing a plan of care for a pregnant client who is complaining of intermittent episodes of constipation. To help alleviate this problem, the nurse should instruct the client to take which measure? 1.Consume a low-fiber diet. 2.Drink 8 glasses of water per day. 3.Use a Fleet enema when the episodes occur. 4.Take a mild stool softener daily in the evening.

4.Evidence of bleeding, such as in the gums, petechiae, and purpura Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.

the nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? 1.Enlargement of the breasts 2.Complaints of feeling hot when the room is cool 3.Periods of fetal movement followed by quiet periods 4.Evidence of bleeding, such as in the gums, petechiae, and purpura

3.An informed consent needs to be signed before the procedure. Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in a health care provider's private office or in a special prenatal testing unit. Hospitalization is not necessary after the procedure.

the nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide? 1.Strict bed rest is required after the procedure. 2.Hospitalization is necessary for 24 hours after the procedure. 3.An informed consent needs to be signed before the procedure. 4.A fever is expected after the procedure because of the trauma to the abdomen.

2.History of syphilis Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion. There is no evidence that genital herpes is a causative agent in abortion, although the presence of active lesions at the time of birth presents concerns. Maternal age greater than 40 and diabetes mellitus are considered high-risk factors in a pregnancy but are related to an increased risk of congenital malformations, not abortions.

the nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, would alert the nurse that the client is at risk for a spontaneous abortion? 1.Age of 35 years 2.History of syphilis 3.History of genital herpes 4.History of diabetes mellitus

1. The woman requires further evaluation for preterm labor. Classic signs and symptoms of preterm labor include lower abdominal cramping, possibly accompanied by diarrhea; dull and intermittent low back pain; painful menstrual-like cramps; suprapubic pain or pressure; pelvic pressure or heaviness; urinary frequency; change in character and amount of vaginal discharge; and rupture of amniotic membranes. Early recognition of preterm labor is essential, so interventions such as tocolytic therapy and administration of antenatal glucocorticoids can be initiated; therefore further evaluation of the cervix, membrane status, uterine activity, and fetal heart rate is necessary to determine if the client is in preterm labor (the correct option). The client's temperature is only slightly elevated and her diarrhea presents in addition to the signs and symptoms of preterm labor, so option 2 can be eliminated. The client is not exhibiting signs of gestational hypertension, so therefore eliminate option 3. Because the client has additional complaints that may possibly relate to preterm labor, instruction on pelvic tilts to decrease back pain is irrelevant at this time so therefore eliminate option 4.

A 25-year-old woman arrives on the maternity unit on February 2. She states that her estimated date of delivery (EDD) is March 22. She is verbalizing complaints of dull lower back pain, pelvic heaviness, and diarrhea for the past few days. On admission for observation, the client's blood pressure is 128/80 mm Hg, pulse is 100 beats/minute, respirations are 16 breaths per minute, and temperature is 99° F. The nurse plans care based on which interpretation? 1. The woman requires further evaluation for preterm labor. 2.The woman is suffering from an intestinal bacterial infection. 3.The woman is exhibiting signs and symptoms of gestational hypertension. 4.The woman needs instruction on pelvic tilts to decrease her lower back pain.

3.Abruptio placentae Trauma increases the incidence of miscarriage, preterm labor, abruptio placentae, and stillbirth. Careful evaluation of mother and fetus after any incidence of trauma is essential. Placenta previa indicates that a placenta is implanted in the lower uterine segment near or over the internal cervical os. Risk factors that may precipitate placenta previa are not related to a traumatic event. Polyhydramnios is a term for excessive amniotic fluid, which would develop over time and would not be a result of trauma. Although a motor vehicle crash may increase a woman's blood pressure, she would not be a candidate for gestational hypertension only because of the traumatic event.

A 35-week-gestation pregnant woman is transferred to the maternity unit from the emergency department, where she was treated for minor injuries sustained in a motor vehicle crash. The maternal nurse's priority will be to assess for which complication? 1.Placenta previa 2.Polyhydramnios 3.Abruptio placentae 4.Gestational hypertension

2.Inevitable An inevitable abortion is a termination of pregnancy that cannot be prevented. Moderate to severe bleeding with mild cramping and cervical dilation would be noted in this type of abortion. A septic abortion manifests with bleeding with odor, cervical dilation, and fever. Cramping may or may not be present. An incomplete abortion manifests with heavy bleeding, severe cramping, cervical dilation, and passage of large clots. A threatened abortion manifests with slight to moderate bleeding and intermittent cramping without dilation.

A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. The nurse determines that the client is experiencing which type of abortion? 1.Septic 2.Inevitable 3.Incomplete 4.Threatened

2."I will maintain strict bed rest throughout the remainder of the pregnancy." Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client also should watch for the evidence of the passage of tissue.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction? 1."I will watch for the evidence of the passage of tissue." 2."I will maintain strict bed rest throughout the remainder of the pregnancy." 3."I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4."I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding."

4."Your baby's heart right now has double heart chambers and has begun to beat, so we should be able to see it beat using an ultrasound machine." By gestational week 5, double heart chambers are visible by ultrasound, and the heart begins to beat. The fetal heart is only two parallel tubes at week 3. At week 5, the heart can be visualized only by ultrasound. To be heard by Doppler, the gestation must be 12 weeks; to be heard by fetoscope, the gestation must be at 20 weeks. By gestational week 5, double heart chambers are visible by ultrasound, and the heart begins to beat. The fetal heart is only two parallel tubes at week 3. At week 5, the heart can be visualized only by ultrasound. To be heard by Doppler, the gestation must be 12 weeks; to be heard by fetoscope, the gestation must be at 20 weeks.

A client who has just been told that she is pregnant wants to know when the baby's heart will be completely developed and beating. The nurse reads in the client's chart that the health care provider has determined the client to be at 6 weeks' gestation. What is the nurse's best response? 1."Your baby's heart right now consists of two parallel tubes, so we can't hear it today." 2."Your baby's heart right now is beginning to partition into four chambers and has begun to beat, so we should be able to hear it with a Doppler." 3."Your baby's heart right now is beginning to partition into four chambers and has begun to beat, so we should be able to hear it with a fetoscope." 4."Your baby's heart right now has double heart chambers and has begun to beat, so we should be able to see it beat using an ultrasound machine."

3.The uterus is stimulated to contract by the administration of small amounts of oxytocin (Pitocin) or by nipple stimulation. A contraction stress test assesses placental oxygenation and function, determines fetal ability to tolerate labor, determines fetal well-being, and is performed if the nonstress test is abnormal. The fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under simulated labor conditions. An external fetal monitor is applied to the mother, and a 20- to 30-minute baseline strip is recorded. The uterus is then stimulated to contract by the administration of a dilute dose of oxytocin (Pitocin) or by having the mother use nipple stimulation until three palpable contractions of 40 seconds or longer in a 10-minute period have occurred. Frequent maternal blood pressure readings are taken, and the client is monitored closely while increasing doses of oxytocin are given. The remaining options are inaccurate.

A contraction stress test is scheduled for a pregnant woman, and she asks the nurse to describe the test. What should the nurse tell the woman? 1.Uterine contractions are stimulated by Leopold's maneuvers. 2.An external fetal monitor is attached, and the woman ambulates on a treadmill until contractions begin. 3.The uterus is stimulated to contract by the administration of small amounts of oxytocin (Pitocin) or by nipple stimulation. 4.Small amounts of oxytocin (Pitocin) are administered during internal fetal monitoring to stimulate uterine contractions.

2."Do you plan to have any other children?" Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure.

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse would determine whether this method of family planning would be most appropriate? 1."Has either of you ever had surgery?" 2."Do you plan to have any other children?" 3."Do either of you have diabetes mellitus?" 4."Do either of you have problems with high blood pressure?"

4."The procedure is performed using artificial insemination of sperm instilled through the vagina." In vitro fertilization is a method of medically assisted reproduction for women with nonpatent, diseased, or missing fallopian tubes or with infertility of unknown cause. Ova and sperm are obtained from the potential parent or donor, placed in a nutrient medium, and allowed to incubate; then the fertilized ovum is transferred into the woman's uterus. The woman houses the pregnancy throughout gestation and gives birth. The correct option describes the procedure for artificial insemination. Options 1, 2, and 3 are correct statements regarding in vitro fertilization.

A couple is seen in the fertility clinic. After several tests, it has been determined that the husband is not sterile and that the wife has nonpatent fallopian tubes. The nurse is preparing the woman and her husband for an in vitro fertilization. Which statement by the woman or her spouse would indicate a need for further information about the procedure? 1."Ova and sperm are collected and allowed to incubate." 2."A fertilized ovum is transferred into the woman's uterus." 3."The procedure is a method of medically assisted reproduction." 4."The procedure is performed using artificial insemination of sperm instilled through the vagina."

3."The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel." Transvaginal ultrasonography allows clear visibility of the uterus, gestational sac, embryo, and deep pelvic structures, such as the ovaries and fallopian tubes. The client is placed in a lithotomy position and a transvaginal probe, encased in a disposable cover and coated with a gel that provides lubrication and promotes conductivity, is inserted into the vagina. The client may feel more comfortable if she is allowed to insert the probe. The procedure takes about 10 to 15 minutes. Options 2 and 4 identify components of abdominal ultrasound.

A health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy and the client asks the nurse about the procedure. How should the nurse respond to the client? 1."The procedure takes about 2 hours." 2."It will be necessary to drink 1 to 2 quarts of water before the examination." 3."The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel." 4."Gel is spread over the abdomen, and a round disk transducer will be moved over the abdomen to obtain the picture."

.Monitor for fetal movement. A client with mild preeclampsia can be managed at home. The priority intervention of the home care nurse is to monitor for fetal movement. The expectant mother also is asked to keep a record of fetal movements. A maternal blood glucose would not provide specific data related to preeclampsia. Bed rest with bathroom privileges is prescribed; complete bed rest is not necessary. Urine should be checked for protein. Sodium restriction is not necessary.

A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit? 1.Monitor for fetal movement. 2.Monitor the maternal blood glucose. 3.Instruct the client to maintain complete bed rest. 4.Instruct the client to restrict dietary sodium and any food items that contain sodium.

2.Reduce external stimuli. The client with severe preeclampsia is kept on complete bed rest in a quiet environment. External stimuli such as lights, noise, and visitors that may precipitate a seizure should be kept to a minimum. Food and fluid are not restricted unless specifically prescribed by the health care provider. The client is instructed to rest in a left lateral position to decrease pressure on the vena cava, thereby increasing cardiac perfusion of vital organs.

A maternity unit nurse is developing a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse should include which nursing intervention in the plan? 1.Restrict food and fluids. 2.Reduce external stimuli. 3.Monitor blood glucose levels. 4.Maintain the client in a supine position.

1.A normal test result Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by three contractions of at least 40 seconds' duration in a 10-minute period. Options 2, 3, and 4 are incorrect interpretations.

A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding? 1.A normal test result 2.An abnormal test result 3.A high risk for fetal demise 4.The need for a cesarean delivery

4."A round, hard plastic disk called an ultrasound transducer picks up and marks the fetal heart activity on the recording paper and is secured over the abdomen." The nonstress test takes about 20 to 30 minutes. The test is termed nonstress because it consists of monitoring only; the fetus is not challenged or stressed by uterine contractions (medication is not given) to obtain the necessary data. The test is noninvasive (an informed consent is not required), and an ultrasound transducer that records fetal heart activity is secured over the maternal abdomen, where the fetal heart is heard most clearly. A tocotransducer that detects uterine activity and fetal movement also is secured to the maternal abdomen. Fetal heart activity and movements are recorded.

A nonstress test is prescribed for a pregnant client, and she asks the nurse about the procedure. How should the nurse respond? 1."The test is a procedure that will require an informed consent to be signed." 2."The test will take about 2 hours and will require close monitoring for 2 hours after the procedure is completed." 3."The test is done to see if the baby can handle the stress of labor, and that medicine is given to make the uterus contract." 4."A round, hard plastic disk called an ultrasound transducer picks up and marks the fetal heart activity on the recording paper and is secured over the abdomen."

2.A 26-year-old client with a family history of thrombophlebitis Certain factors create a risk for the development of thrombophlebitis. These factors include smoking; varicose veins; obesity; a history of thrombophlebitis; women who are older than 35 years or have had more than three pregnancies; and women who have had a cesarean birth. The client described in the correct option is least likely at risk for the development of a thromboembolic disorder because this client has a family history rather than a personal history of thrombophlebitis.

A nurse is collecting data on clients who are in their first trimester of pregnancy. The nurse is concerned with identifying clients who may be at risk for the development of postpartum complications. Which client would be least likely at risk for the development of thrombophlebitis in the postpartum period? 1.A 35-year-old client who reports that she smokes 2.A 26-year-old client with a family history of thrombophlebitis 3.A 37-year-old client in her fourth pregnancy who is overweight 4.A 22-year-old client in her first pregnancy who states that oral contraceptives taken in the past have caused thrombophlebitis

4."When I get home I should lie on the floor, with my legs elevated onto a couch, and turn my hips and knees at right angles." Lying on the floor with the legs elevated onto a couch with the hips and knees at right angles will produce a posture of pelvic tilt while countering gravity, which is the force that leads to edema of the lower extremities. Although the other options might seem useful, remember that heat needs to be prescribed by a health care provider (HCP). Lying on the left side with the feet dorsiflexed may help with the reduction of hemorrhoids.

A nurse provides teaching regarding how to relieve discomfort to a client in her second trimester of pregnancy that is having frequent low back pain and ankle edema at the end of the day. Which statement made by the client indicates an understanding of the teaching? 1."When I get home I should lie on my left side, with my feet in a dorsiflexed position." 2."I should soak in a tub bath of hot water when I get home and then perform pelvic tilt exercises." 3."When I get home I should lie on my right side, with my feet elevated on a pillow, and put a heating pad on my back." 4."When I get home I should lie on the floor, with my legs elevated onto a couch, and turn my hips and knees at right angles."

3.Phenytoin (Dilantin) An antiseizure medication (specifically phenytoin) taken during pregnancy is a known risk factor in the development of cleft lip and cleft palate. Methyldopa is used during pregnancy for maintenance in women with chronic hypertension. Folic acid use is recommended during pregnancy to reduce the risk of cleft lip and palate. The use of an antidepressant (bupropion) has not been found to increase a woman's risk of developing a fetus with cleft lip or palate. Although bupropion can be used for smoking cessation, and maternal smoking can contribute to the development of cleft lip, taking bupropion does not increase a woman's risk of having a fetus affected by cleft lip or palate.

A nurse working in an infertility clinic reviews the medical history of a 35-year-old woman who is currently taking fertility medications and is planning a pregnancy. Which medication, if present in the client's history, would indicate a need for teaching related to the woman's potential risk for carrying a fetus with a congenital cleft lip or cleft palate? 1.Methyldopa 2.Folic acid (Folvite) 3.Phenytoin (Dilantin) 4.Bupropion (Wellbutrin SR)

3.Connects the umbilical vein to the inferior vena cava The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

A nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement is correct regarding the ductus venosus? 1.Connects the pulmonary artery to the aorta 2.Is an opening between the right and left atria 3.Connects the umbilical vein to the inferior vena cava 4.Connects the umbilical artery to the inferior vena cava

1.Swimming Non-weight-bearing exercises are preferable to weight-bearing exercises during pregnancy. Exercises to avoid are shoulder standing and bicycling with the legs in the air because the knee-chest position should be avoided. Competitive or high-risk sports such as scuba diving, water skiing, downhill skiing, horseback riding, basketball, volleyball, and gymnastics should be avoided. Non-weight-bearing exercises such as swimming are allowable.

A pregnant client asks the nurse about the types of exercises that are allowable during pregnancy. The nurse should tell that client that which exercise is safest? 1.Swimming 2.Scuba diving 3.Low-impact gymnastics 4.Bicycling with the legs in the air

4.14 and 18 Quickening is fetal movement that is felt by the mother. In the multiparous woman this may occur as early as the fourteenth to sixteenth weeks. The nulliparous woman may not notice these sensations until the eighteenth week or later. Options 1, 2, and 3 are incorrect time frames because quickening does not occur this early during pregnancy.

A pregnant client asks the nurse in the clinic when she will be able to begin to feel the fetus move. The nurse responds by telling the mother that fetal movements will be noted between which weeks of gestation? 1.6 and 8 2.8 and 10 3.10 and 12 4.14 and 18

3."You were wise to call. Your rubella titer indicates that you are immune and your baby is not at risk." Rubella virus is spread by aerosol droplet transmission through the upper respiratory tract and has an incubation period of 14 to 21 days. The risks of maternal and subsequent fetal infection during the second trimester include hearing loss and congenital anomalies; these risks decrease after the first 12 weeks of pregnancy. Rubella titer determination is a standard antenatal test for pregnant women during their initial screening and entry into the health care delivery system. As noted in this client's chart, she is immune to rubella. The correct option is the only option that helps clarify maternal concerns with accurate information.

A pregnant client at 10 weeks' gestation calls the prenatal clinic to report a recent exposure to a child with rubella. The nurse reviews the client's chart. What is the nurse's best response to the client? Refer to chart. 1."You should avoid all school-age children during pregnancy." 2."There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3."You were wise to call. Your rubella titer indicates that you are immune and your baby is not at risk." 4."Be sure to tell the health care provider in 2 weeks as additional screening will be prescribed during your second trimester."

2.Pain, itching, and vaginal discharge Clinical manifestations of a vaginal Candida infection include pain, itching, and a thick, white vaginal discharge. Proteinuria, hematuria, edema, hypertension, and costovertebral angle pain are clinical manifestations that may be associated with urinary tract infections.

A pregnant client has been diagnosed with a vaginal infection from the organism Candida albicans. Which finding should the nurse expect to note when assessing this client? 1.Costovertebral angle pain 2.Pain, itching, and vaginal discharge 3.Absence of any signs and symptoms 4.Proteinuria, hematuria, edema, and hypertension

2."This test measures amniotic fluid volume and fetal activity." The biophysical profile assesses five parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume. In a biophysical profile, each of the five parameters contributes 0 to 2 points, with a score of 8 considered normal and a score of 10 perfect. Results are available immediately. Options 1, 3, and 4 are incorrect.

A pregnant client in the prenatal clinic is scheduled for a biophysical profile. The client asks the nurse what this test involves. The nurse should make which appropriate response? "This test measures your ability to tolerate the pregnancy." 2."This test measures amniotic fluid volume and fetal activity." 3."This test measures your cardiac status and ability to tolerate labor." 4."This test only measures the amount of amniotic fluid present in the uterus."

2.Assess for signs of venous thrombosis. If a woman complains of calf pain during walking, it could be an indication of venous thrombosis of the lower extremities. The most appropriate nursing action would be to check for the presence of additional signs of venous thrombosis. It is not appropriate to tell the mother that this is normal during pregnancy. Ambulation is a necessary exercise, and the woman should be encouraged to ambulate during pregnancy. Although it is important to elevate the legs during pregnancy, elevating the legs consistently is not the most appropriate nursing action.

A pregnant client is seen in the health care clinic. During the prenatal visit, the client informs the nurse that she is experiencing pain in her calf when she walks. Which is the most appropriate nursing action? 1.Instruct the client to avoid walking. 2.Assess for signs of venous thrombosis. 3.Instruct to elevate the legs throughout the day. 4.Tell the client that this is normal during pregnancy.

4.Isoniazid plus rifampin (Rifadin) will be required for 9 months. More than one medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamin B6) often is administered with isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required.

A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After assessment of the client, tuberculosis is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan? 1. Therapeutic abortion is required. 2.She will have to stay at home until treatment is completed. 3.Medication will not be started until after delivery of the fetus. 4.Isoniazid plus rifampin (Rifadin) will be required for 9 months.

1.The appearance of the fetal external genitalia By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the gender of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and female occur at the end of the seventh week.

A pregnant client tells the clinic nurse that she wants to know the gender of her baby as soon as it can be determined. The nurse understands that the client should be able to find out the gender at 12 weeks' gestation because of which factor? 1.The appearance of the fetal external genitalia 2.The beginning of differentiation in the fetal groin 3.The fetal testes are descended into the scrotal sac 4.The internal differences in males and females become apparent

4."I should do more exercises to strengthen my back muscles." Some measures that will assist in relieving a backache include maintaining good posture and body mechanics, resting and avoiding fatigue, wearing flat-heeled shoes, and sleeping on a firm mattress. The back discomfort that occurs in a pregnant client is often caused by the exaggerated lumbar and cervicothoracic curves resulting from a change in the center of gravity because of the enlarged uterus. Performing more exercises to strengthen the back muscles could be harmful to a pregnant client.

A pregnant client visits a clinic for a scheduled prenatal appointment. The client tells the nurse that she frequently has a backache, and the nurse provides instructions regarding measures that will assist in relieving the backache. Which statement by the client indicates a need for further instructions? 1."I should wear flat-heeled shoes." 2."I should sleep on a firm mattress." 3."I should try to maintain good posture." 4."I should do more exercises to strengthen my back muscles."

4."You were wise to call. I will check your rubella titer screening results, and we can immediately identify whether future interventions are needed." Rubella virus is spread by aerosol droplet transmission through the upper respiratory tract and has an incubation period of 14 to 21 days. The risks associated with maternal and subsequent fetal infection during the second trimester include hearing loss and congenital anomalies. Rubella titer determination is a standard antenatal test for childbearing women during their initial screening and entry into the health care delivery system. The correct option helps clarify maternal concerns with accurate information based on the acquisition of rubella infection and potential fetal side effects.

A pregnant woman in her second trimester calls the prenatal clinic nurse to report a recent exposure to a child with rubella. Which response by the nurse would be most appropriate and supportive to the woman? 1."You should avoid all school-age children during pregnancy." 2."There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3."Be sure to tell the health care provider on your next prenatal visit, but there is little risk in the second trimester." 4."You were wise to call. I will check your rubella titer screening results, and we can immediately identify whether future interventions are needed."

2.Retesting rubella titer during pregnancy A rubella titer is performed to determine immunity to rubella. If the client's titer is less than 1:8, the mother is not immune. A retest during pregnancy is prescribed, and the mother is immunized postpartum if she is not immune. Antibiotics are not prescribed. Counseling the client regarding therapeutic abortion is an inaccurate option.

A rubella titer is performed on a client who has just been told that she is pregnant. The results of the titer indicate that the client is not immune to rubella. Which should the nurse anticipate to be prescribed for this client? 1.Immunization with rubella 2.Retesting rubella titer during pregnancy 3.Antibiotics to be taken throughout the pregnancy 4.Counseling the mother regarding therapeutic abortion

1.Apply heat to the affected area. Leg cramps may be a result of compression of the nerves supplying the legs by the enlarging uterus, a reduced level of diffusible serum calcium, or an increase in serum phosphorus. In the pregnant woman who complains of leg cramps, the nurse would perform further assessments to ensure that the client is not experiencing thrombophlebitis. Once this has been ruled out, the nurse would instruct the woman to place heat on the affected area, dorsiflex the foot until the spasm relaxes, or stand and walk. The health care provider may prescribe oral supplementation with calcium carbonate tablets or calcium hydroxide gel with each meal to increase the calcium level and lower the phosphorus level, but the nurse would not prescribe these or any other medications.

A woman in the third trimester of pregnancy visits the clinic for a scheduled prenatal appointment. The woman tells the nurse that she frequently has leg cramps, primarily when she is reclining. Once thrombophlebitis has been ruled out, the nurse should tell the woman to implement which measure to alleviate the leg cramps? 1.Apply heat to the affected area. 2.Take acetaminophen (Tylenol) every 4 hours. 3.Self-administer calcium carbonate tablets three times daily. 4.Purchase a chewable antacid that contains calcium and take a tablet with each meal.

3.Weight increases by more than 1 pound in a week. The nurse would instruct the client to report any increase in blood pressure, protein in the urine, weight gain greater than 1 pound per week, or edema. The client also is taught how to count fetal movements and is instructed that decreased fetal activity (three or fewer movements per hour) may indicate fetal compromise and should be reported

A woman in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home. The home care nurse teaches the woman about the signs that need to be reported to the health care provider. The nurse should tell the woman to call the health care provider if which occurs? 1.Urine tests negative for protein. 2.Fetal movements are more than four per hour. 3.Weight increases by more than 1 pound in a week. 4.The blood pressure reading is ranging between 122/80 and 132/88 mm Hg.

4."I will eat fresh fruits and vegetables for snacks and for dessert each day." Fresh fruits and vegetables provide vitamins and minerals needed for healthy gums. Drinking water with meals has no direct effect on gums. Cracked wheat bread may abrade the tender gums. Eating saltine crackers can also abrade the tender gums.

During a routine prenatal visit, a client complains of gums that bleed easily with brushing. The nurse performs an assessment and teaches the client about proper nutrition to minimize this problem. Which client statement indicates an understanding of the proper nutrition to minimize this problem? 1."I will drink 8 oz of water with each meal." 2."I will eat three servings of cracked wheat bread each day." 3."I will eat two saltine crackers before I get up each morning." 4."I will eat fresh fruits and vegetables for snacks and for dessert each day."

1.Normal A reactive nonstress test is a normal result. To be considered reactive, the baseline fetal heart rate must be within normal range (120 to 160 beats/minute) with good long-term variability. In addition, two or more fetal heart rate accelerations of at least 15 beats/minute must occur, each with a duration of at least 15 seconds, in a 20-minute interval.

The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The nurse interprets the test as reactive. How should the nurse document this finding? 1.Normal 2.Abnormal 3.The need for further evaluation 4.That findings were difficult to interpret

2.The 26-year-old, gravida I, para 0 client who is at 10 weeks' gestation and is experiencing vaginal bleeding The fetus of the client at 10 weeks' gestation is in a pre-viability stage, whereas those of the other clients are at a stage of viability. There is limited monitoring that can be done with a 10-week fetus; Doppler monitoring is not feasible during the first trimester. Bed rest would be the primary treatment for this client at this point in her pregnancy. Bed rest could be maintained, and bleeding could be monitored by a postpartum nurse. The clients with preterm and postterm gestations (24 and 42 weeks, respectively) are those most at risk, so these clients would require more fetal monitoring. The woman who is at 38 weeks' gestation is also in need of fetal monitoring because of a possibility of decreased fetal movement. Until the fetal well-being can be confirmed with fetal monitoring, this client should remain on the labor and delivery unit where she can be continuously monitored. Additionally, the two older clients (36 and 40 years) are considered to be of advanced maternal age, indicating a need for closer monitoring.

The charge nurse on a labor and delivery unit has numerous admissions of laboring clients and must transfer one of the clients to the postpartum/gynecological unit, where the nurse-to-client ratio will be 1:4. Which antepartum client would be the most appropriate one to transfer? 1. The 36-year-old, gravida I, para 0 client who is at 24 weeks' gestation and is being monitored for preterm labor 2.The 26-year-old, gravida I, para 0 client who is at 10 weeks' gestation and is experiencing vaginal bleeding 3.The 40-year-old, gravida III, para 0 client who is at 38 weeks' gestation and is complaining of decreased fetal movement 4.The 29-year-old, gravida I, para 0 client who is at 42 weeks' gestation and had a biophysical profile score of 5 earlier today

2.Dried fruits The best source of calcium is dairy products. Women with lactose intolerance need other sources of calcium. Calcium is present in dark green leafy vegetables, broccoli, legumes, nuts, and dried fruits. Cheese is a dairy product and is not tolerated by the client with lactose intolerance. Spinach contains calcium, but it also contains oxalates that decrease calcium availability. Additionally, creamed spinach may not be tolerated by a client with lactose intolerance. Orange juice does not contain significant amounts of calcium unless fortified with calcium.

The clinic nurse is discussing nutrition with a pregnant client who has lactose intolerance. The nurse should instruct the client to supplement the dietary source of calcium by eating which food? 1.Hard cheese 2.Dried fruits 3.Creamed spinach 4.Fresh-squeezed orange juice

3.Pregnancy greatly increases the risk of malnourishment for the mother. Although pregnancy poses some nutritional risk for the mother, the client is not at risk of becoming malnourished. Intake of dietary iron is usually insufficient for most pregnant women, and iron supplements are routinely encouraged. Calcium is critical during the third trimester but must be increased from the onset of pregnancy Good nutrition during pregnancy significantly and positively influences fetal growth and development.

The clinic nurse is instructing a pregnant client in her first trimester about nutrition. The nurse should determine that the client needs further teaching if the client believes which is true about nutrition during pregnancy? 1.Iron supplements should be taken throughout pregnancy. 2.Calcium intake should be increased for the duration of the pregnancy. 3.Pregnancy greatly increases the risk of malnourishment for the mother. 4.The maternal diet significantly influences fetal growth and development.

3.The client has a history of hypertension.

The clinic nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to the risk of abruptio placentae if which information is obtained on assessment? 1.The client is 28 years of age. 2.This is the second pregnancy. 3.The client has a history of hypertension. 4.The client performs moderate exercise on a regular daily schedule.

1.A client who has a history of intravenous drug use Human immunodeficiency virus (HIV) is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include individuals with persistent and recurrent sexually transmitted infections, individuals who have a history of multiple sexual partners, and individuals who have used intravenous drugs. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment finding indicates to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? 1.A client who has a history of intravenous drug use 2.A client who has a significant other who is heterosexual 3.A client who has a history of sexually transmitted infections 4.A client who has had one sexual partner for the past 10 years

2.Discuss the need for hospitalization. With mild cases of preeclampsia, the condition is monitored with self-care and bed rest at home. Before the need for hospitalization is discussed, the woman would need to be assessed for progression of the disease process. The nurse must assess blood pressure, weight, and the presence of edema because an increase in these areas would indicate a worsening condition

The clinic nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Of the following interventions, which should the nurse list as having the lowest priority in planning nursing care for this client? 1.Assess blood pressure. 2.Discuss the need for hospitalization. 3.Assess deep tendon reflexes and edema. 4.Teach the importance of keeping track of a daily weight.

4.Presence of irregular painless contractions Braxton Hicks contractions are the normal, irregular, painless contractions of the uterus that may occur throughout pregnancy. Rapid weight gain, visual disturbances, and generalized or facial edema are warning signs in pregnancy. Additional warning signs in pregnancy include vaginal bleeding, premature rupture of the membranes, preterm uterine contractions that are normal and regular, change in or absence of fetal activity, severe headache, epigastric pain, persistent vomiting, abdominal pain, and signs of infection.

The clinic nurse is teaching a pregnant woman about the warning signs in pregnancy. Which, if identified as a warning sign by the woman, would indicate a need for further education? 1.Rapid weight gain 2.Visual disturbances 3.Generalized or facial edema 4.Presence of irregular painless contractions

1.Proteinuria 2.Hypertension 4.Generalized edema

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. 1.Proteinuria 2.Hypertension 3.Low-grade fever 4.Generalized edema 5.Increased pulse rate 6.Increased respiratory rate

3.Restrict visitors who may have an active infection. The client should avoid exposure to infection and not allow those persons with active infections to visit. Too much weight gain causes an increase in body requirements and increases stress on the heart. The client should rest on the left side to promote blood return. Stress causes increased heart workload, with the potential for adverse consequences.

The home care nurse is visiting a prenatal client who has a history of heart disease. The nurse provides instructions to the client regarding home care measures to promote a healthy pregnancy. Home care for this client should include which measure? 1.Increase daily calories to ensure weight gain. 2.Maintain a supine position during rest periods. 3.Restrict visitors who may have an active infection. 4.Avoid becoming concerned about placing stress on the heart.

1.Reduce excessive maternal stress and fatigue A variety of factors can cause increased emotional stress during pregnancy, resulting in further cardiac complications. The client with known cardiac disease is at greater risk for such complications. The use of resources will assist the client to avoid emotional stress, thus reducing additional cardiac compromise during the last trimester. These resources are not intended to minimize potential risk of maternal infection or prepare the client and family for the subsequent labor, delivery, and hospitalization.

The nurse assists a pregnant client with cardiac disease to identify resources to help her care for her 18-month-old child during the last trimester of pregnancy. The nurse encourages the pregnant client to use these resources primarily for which reason? 1.Reduce excessive maternal stress and fatigue. 2.Help the mother prepare for labor and delivery. 3.Avoid exposure to potential pathogens and resulting infections. 4.Prepare the 18-month-old child for maternal separation during hospitalization.

4."I should wear knee-high hose, but I should not leave them on longer than 8 hours." Varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and to minimize falls.

The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instructions? 1."I should wear panty hose." 2."I should wear support hose." 3."I should wear flat nonslip shoes that have good support." 4."I should wear knee-high hose, but I should not leave them on longer than 8 hours."

3."It promotes the fertilized ovum's normal implantation in the top portion of the uterus." The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days.

The nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the nurse's best response? 1."It promotes the fertilized ovum's chances of survival." 2."It promotes the fertilized ovum's exposure to estrogen and progesterone." 3."It promotes the fertilized ovum's normal implantation in the top portion of the uterus." 4."It promotes the fertilized ovum's exposure to luteinizing hormone and follicle-stimulating hormone."

1.Increase in pulse rate Between 14 and 20 weeks' gestation, the pulse rate increases about 10 to 15 beats/minute, which then persists to term. Options 2, 3, and 4 are incorrect. During pregnancy, the blood pressure usually is the same as the prepregnancy level, but then gradually decreases up to about 20 weeks of gestation. During the second trimester, systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Constipation may occur as a result of decreased gastrointestinal motility or pressure of the uterus. During pregnancy, there is an accelerated production of red blood cells.

The nurse is describing cardiovascular system changes that occur during pregnancy to a client and understands that which finding would be normal for a client in the second trimester? 1.Increase in pulse rate 2.Increase in blood pressure 3.Frequent bowel elimination 4.Decrease in red blood cell production

4.Whole-grain cereal Dietary sources of iron include lean meats; liver; shellfish; dark green, leafy vegetables; legumes; whole grains and enriched grains; cereals; and molasses. Milk is high in calcium and also contains phosphorus. Cantaloupe and potatoes are high in vitamin C.

The nurse is instructing a pregnant client regarding measures to increase iron in the diet. The nurse should tell the client to consume which food that contains the highest source of dietary iron? 1.Milk 2.Potatoes 3.Cantaloupe 4.Whole-grain cereal

4."I don't like my face any more. I always look like I have been crying." In the correct option, there is an implication of periorbital and facial edema, which could be indicative of gestational hypertension. The question identifies an adolescent who has not sought early prenatal care. Such clients are at higher risk for the development of gestational hypertension. Although the remaining options also deal with body image, and these comments should not be ignored, the need for follow-up is not urgent.

The nurse is interviewing a 16-year-old client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation? 1."I don't like my figure anymore. My clothes are all too tight." 2."I don't like my breasts anymore. These silver lines are ugly." 3."I don't like my stomach anymore. That brown line is disgusting." 4."I don't like my face any more. I always look like I have been crying."

4.Midway between the symphysis pubis and the umbilicus At 16 weeks' gestation, the fundus reaches midway between the symphysis pubis and the umbilicus. At 20 weeks' gestation, the fundus is located at the umbilicus. At 12 weeks' gestation, the uterus extends out of the maternal pelvis and can be palpated above the symphysis pubis. By 36 weeks' gestation, the fundus reaches its highest level at the xiphoid process.

The nurse is performing an assessment on a pregnant client at 16 weeks of gestation. On assessment, the nurse expects the fundus of the uterus to be located at which area? 1.At the umbilicus 2.Just above the symphysis pubis 3.At the level of the xiphoid process 4.Midway between the symphysis pubis and the umbilicus

3.Monitoring the apical pulse Nursing care for the client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock. Weight and edema are priority interventions for the client with preeclampsia, and an elevated temperature is an indicator of infection.

The nurse is preparing to care for a client who is being admitted to the hospital with a possible diagnosis of ectopic pregnancy. The nurse develops a plan of care for the client and determines that which nursing action is the priority? 1.Checking for edema 2.Monitoring daily weight 3.Monitoring the apical pulse 4.Monitoring the temperature

3."I should apply heat packs to the hemorrhoids to help them shrink." ce packs; warm or cold sitz baths; gentle cleansing; or topical ointments and anesthetic agents. Kegel exercises help strengthen the perineum. Hot packs will increase the blood flow to the area and worsen the discomfort from hemorrhoids.

The nurse is providing instructions about treatment for hemorrhoids to a client in the second trimester of pregnancy. Which statement made by the client indicates a need for further teaching? 1."Cool sitz baths will help in relieving the discomfort." 2."I should perform Kegel exercises as you have instructed." 3."I should apply heat packs to the hemorrhoids to help them shrink." 4."I can apply ice packs to the hemorrhoids to assist in relieving discomfort."

4.Leafy green vegetables\ Rationale:Leafy green vegetables are rich in folate (folic acid). Bananas provide potassium; milk and yogurt supply calcium.

The nurse is reviewing a nutritional plan of care with a pregnant client and is identifying the food items highest in folic acid. The nurse determines that the client understands the foods that supply the highest amounts of folic acid if the client states that she will include which item in the daily diet? 1.Milk 2.Yogurt 3.Bananas 4.Leafy green vegetables

4.It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat; it is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

The nurse is teaching a pregnant client about the physiological effects and hormonal changes that occur during pregnancy. The client asks the nurse about the purpose of estrogen. Which response should the nurse give the client for the purpose of estrogen? 1.It maintains and relaxes the uterine lining for implantation. 2.It stimulates metabolism of glucose and converts the glucose to fat. 3.It prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. 4.It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation.

3."The iron is best absorbed if taken on an empty stomach." Iron is needed to allow for transfer of adequate iron to the fetus and to permit expansion of the maternal red blood cell mass. During pregnancy, the relative excess of plasma causes a decrease in the hemoglobin concentration and hematocrit, known as physiological anemia of pregnancy. This is a normal adaptation during pregnancy. Iron is best absorbed if taken on an empty stomach with water or a vitamin C containing juice. Iron supplements usually cause constipation. Meats are an excellent source of iron. The client needs to take the iron supplements regardless of food intake.

The nurse provides instructions to a malnourished pregnant client regarding iron supplementation. Which client statement indicates an understanding of the instructions? 1."Iron supplements will give me diarrhea." 2."Meat does not provide iron and should be avoided." 3."The iron is best absorbed if taken on an empty stomach." 4."On the days that I eat green leafy vegetables or calf liver I can omit taking the iron supplement."

2.Present in low levels An abnormal pregnancy (ectopic) is suspected if β-hCG is present but at lower levels than expected. The absence of β-hCG would indicate no pregnancy, whereas normal limits could indicate a normal pregnancy. High levels could indicate a molar pregnancy.

The nurse reviews the laboratory results for a client with a suspected ectopic pregnancy. The nurse would expect which result of the beta subunit of human chorionic gonadotropin (β-hCG) if the client had an ectopic pregnancy? 1.Not present 2.Present in low levels 3.Present in high levels 4.Within normal limits

3.Insufficient fluid volume In a client with sickle cell anemia, dehydration will precipitate sickling of the red blood cells. Sickling can lead to life-threatening consequences for the pregnant woman and for the fetus, such as an interruption of blood flow to the placenta. Although the remaining options may also be appropriate problems for the client with sickle cell anemia, they are not the priority.

The nurse reviews the plan of care for a woman at 37 weeks' gestation who has sickle cell anemia. The nurse determines that which problem listed on the nursing care plan will receive the highest priority? 1.Pain 2.Disturbed body image 3.Insufficient fluid volume 4.Inability to tolerate activity

2."Your type of pelvis is the most favorable for labor and birth." A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

The nurse should include which statement to a pregnant client found to have a gynecoid pelvis? 1."Your type of pelvis has a narrow pubic arch." 2."Your type of pelvis is the most favorable for labor and birth." 3."Your type of pelvis is a wide pelvis, but has a short diameter." 4."You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery."

1. Allows for fetal movement 2.Surrounds, cushions, and protects the fetus 3.Maintains the body temperature of the fetus 4.Can be used to measure fetal kidney function The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.

The nursing instructor asks a nursing student to list the characteristics of the amniotic fluid. The student responds correctly by listing which as characteristics of amniotic fluid? Select all that apply. 1. Allows for fetal movement 2.Surrounds, cushions, and protects the fetus 3.Maintains the body temperature of the fetus 4.Can be used to measure fetal kidney function 5.Prevents large particles such as bacteria from passing to the fetus 6.Provides an exchange of nutrients and waste products between the mother and the fetus

1."Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high." Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high, inhibiting the release of follicle-stimulating and luteinizing hormones, which are necessary for ovulation. All other options are incorrect.

The nursing instructor asks the nursing student about the physiology related to the cessation of ovulation that occurs during pregnancy. Which response, if made by the student, indicates an understanding of this physiological process? 1."Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high." 2."Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are low." 3."The low levels of estrogen and progesterone increase the release of the follicle-stimulating hormone and luteinizing hormone." 4."The high levels of estrogen and progesterone promote the release of the follicle-stimulating hormone and luteinizing hormone."

3.Place the fetal heart monitor on the client in order to do a nonstress test (NST). The BPP includes five components, one of which is an NST. Each of these components allows the practitioners to assess if the central nervous system is fully functional and that the fetus is not hypoxemic. Four components are included in the ultrasound portion of the profile in addition to an NST: fetal breathing movements, fetal movements, fetal tone, and amniotic fluid index. Each of the five components is given a score of either 2 or 0. Zero indicates an abnormal result and a 2 indicates a normal result. After the ultrasound components, the client's BPP was an 8 out of 8 possible points. This indicates fetal well-being, but there is a need to complete the BPP by obtaining an NST. Option 1 can be eliminated because the BPP result thus far is normal. Option 2 can be eliminated because the client's gestational age is not term, and the BPP reveals no abnormalities, thus the need for induction. To complete a BPP, an NST must be done; therefore, it is inappropriate to send the client home at this point in her care, so option 4 can be eliminated.

The result of a biophysical profile (BPP) of a 28-year-old client at 36 weeks' gestation after the ultrasound components is 8. Based on this result, the nurse should take which action? 1.Notify the health care provider. 2.Prepare the client for labor induction. 3.Place the fetal heart monitor on the client in order to do a nonstress test (NST). 4.Provide the client with information regarding warning signs and symptoms of pregnancy and discharge her to home.

4."I should drink at least 8 to 10 glasses of fluid each day, of which at least 6 glasses should be water." The nurse should instruct the client to have an adequate fluid intake daily to assist in digestion and in the management of constipation. The pregnant client should consume at least 8 to 10 (8-oz) glasses of fluid each day, of which at least 6 glasses should be water. It is not necessary for the client to drink 12 glasses of fruit juices and milk every day. Because of their sodium content, diet soft drinks should be consumed in moderation. Caffeinated beverages have a diuretic effect, which may be counterproductive to increasing fluid intake.

clinic nurse is instructing a pregnant client regarding dietary measures to promote a healthy pregnancy. The nurse tells the client about the importance of an adequate daily fluid intake. Which client statement best indicates an understanding of the daily fluid requirement? 1."I should drink 12 glasses of fruit juices and milk every day." 2."I should drink 8 to 10 glasses of fluid a day, and I can drink as many diet soft drinks as I want." 3."I should drink 12 glasses of fluid a day, and I can include the coffee or tea that I drink in the count." 4."I should drink at least 8 to 10 glasses of fluid each day, of which at least 6 glasses should be water."

1.Viruses 3.Nutrients 4.Medications 5.Antibodies Large particles such as bacteria cannot pass through the placenta, but viruses, nutrients, medications, antibodies, and recreational drugs can pass through the placenta and potentially affect the fetus.

he prenatal client asks the nurse about substances that can cross the placental barrier and potentially affect the fetus. The nurse most appropriately explains that which substances can cross this barrier? Select all that apply. 1.Viruses 2.Bacteria 3.Nutrients 4.Medications 5.Antibodies