Antepartum: NCLEX

A client who is pregnant has been instructed on prevention of genital tract infections. Which statement by the client indicates an understanding of these prevention measures?

"I should choose underwear with a cotton panel liner." (Condoms should be used to minimize the spread of sexually transmitted infectious diseases. Wearing tight clothes irritates the genital area and does not allow for air circulation. Douching is to be avoided. Wearing items with a cotton panel liner allows for air movement in and around the genital area.)

A nurse is preparing to monitor a fetal heart rate. The nurse knows that the fetal heart rate can first be heard with a fetoscope at gestational week:

20 (The fetal heart rate can first be heard with a fetoscope at 18 to 20 weeks of gestation. If a Doppler ultrasound device is used, the fetal heart rate can be detected as early as 10 weeks of gestation.)

A perinatal client is at risk for toxoplasmosis. The nurse should teach the client which of the following to prevent exposure to this disease?

Avoid exposure to litter boxes used by cats. (Infected house cats transmit toxoplasmosis through feces. Handling litter boxes can transmit the disease to the maternity client. Meats that are undercooked can harbor microorganisms that can cause infection. Hands should be washed throughout the day when items that could be contaminated are handled. Topical corticosteroid treatment is not the pharmacological treatment of choice for toxoplasmosis.)

A nurse employed in a health care provider's office is collecting information from a pregnant client. Which of the following statements made by the client likely indicates the need for psychological referral?

"I hate the way I look and feel. The baby has done this to me and I wish I were not pregnant." (Options 1, 2, and 4 are feelings about self and body image that many women express during pregnancy. The statement in option 3 is much stronger and places blame on the fetus. The direction of anger to the fetus should be explored. The nurse may find that a psychological referral is appropriate.)

The nurse is collecting data from a pregnant client who is at 28 weeks' gestation. The nurse measures the fundal height in centimeters and expects the findings to be which of the following?

28 cm (During the second and third trimesters (18 to 30 weeks' gestation), the fundal height in centimeters approximately equals the fetus' age in weeks plus or minus 2 cm. At 14 to 16 weeks' gestation, the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks' gestation, the fundus is at the umbilicus, and, at term, the fundus is at the xiphoid process.)

A client who has just been told that she is pregnant asks a clinic nurse when the fetus's heart will be developed and beating. The nurse tells the client that the fetal heart is beating at what gestational week?

5 (The fetal heart is beating and has developed four chambers by gestational week 5.)

A client with severe preeclampsia is receiving magnesium sulfate by intravenous infusion. The nurse reviews the laboratory results, knowing that which value is a therapeutic magnesium level?

6 mg/dL (The therapeutic range for magnesium sulfate is approximately 5 to 8 mg/dL. The remaining options are incorrect.)

A nurse is collecting data from a prenatal client. The nurse determines that which of the following places the client in the high-risk category for contracting human immunodeficiency virus (HIV)?

A history of intravenous (IV) drug use in the past year (HIV is transmitted by intimate sexual contact and by the exchange of body fluids, exposure to infected blood, and the transmission from an infected woman to her fetus. Women who fall into the high-risk category for HIV infection include those with persistent and recurrent sexually transmitted diseases or a history of multiple sexual partners and those who use or have used IV drugs)

A nonstress test is performed on a client, and the results are documented in the chart. The results are documented as a reactive nonstress test. The nurse interprets these findings as indicating:

A negative test (A reactive nonstress test (normal/negative) indicates a healthy fetus. A nonreactive nonstress test is an abnormal test and requires further followup. A suspicious test result also requires further followup. An unsatisfactory test cannot be interpreted because of the poor quality of the fetal heart rate findings.)

A nurse is teaching a prenatal class on the anatomy and physiology of the female reproductive system. When a participant in the class asks where the follicle-stimulating hormone is produced, the nurse responds that it is produced in the:

Anterior pituitary gland (The follicle-stimulating hormone and luteinizing hormone are produced by the anterior pituitary gland. The ovaries are the endocrine glands that produce estrogen and progesterone. Oxytocin is produced by the posterior pituitary gland and stimulates the uterus to produce contractions during birth. The pancreas produces insulin and other enzymes that aid in digestion.)

A nurse in the prenatal clinic is collecting data regarding the client's nutritional knowledge. The nurse determines that the client understands the food items that are high in folic acid when the client states that she will be sure to eat:

Beans (Sources of folic acid include green, leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Cheese is high in calcium, and rice and chicken are good sources of iron.)

A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the mother that fetal movements will be noted:

Between 16 and 20 weeks' gestation (Fetal movement, called quickening, is not perceived until the second trimester. Between 16 and 20 weeks of gestation the expectant mother first notices subtle fetal movements that gradually increase in intensity.)

A nurse is assisting in caring for a client who has a placenta previa. The nurse understands that a cervical examination will not be performed on the client primarily because it could do which of the following?

Cause profound hemorrhage (Because the placenta is implanted low in the uterus, cervical examination could cause the disruption of the placenta and initiate profound hemorrhage. The other options are also correct, but the profound hemorrhage is of the greatest concern in this case.)

A nurse is assisting in planning care for a client with a diagnosis of placenta previa. The nurse identifies which of the following as the priority goal for the client?

Client exhibits no signs of fetal distress. (Option 1 clearly identifies a physiological need.)

While assisting with the measurement of fundal height, the client at 36 weeks' gestation states that she is feeling lightheaded. On the basis of the nurse's knowledge of pregnancy, the nurse determines that this is most likely a result of:

Compression of the vena cava (Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome during pregnancy. Having the woman turn onto her left side or elevating the right buttock during fundal height measurement will prevent or correct the problem.)

A nursing student is assigned to a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. The instructor determines that the student understands the structure of the ductus venosus if the student states that it:

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 nurse is caring for a client receiving magnesium sulfate for preeclampsia. During the administration of this medication, the nurse should specifically monitor which of the following?

Deep tendon reflexes (Loss of reflexes is often the first sign of developing toxicity. The nurse should assess knee jerk (patellar tendon reflex) for evidence of diminished or absent reflexes. Although options 1, 2, and 4 may be components of the assessment, these are not specifically associated with this medication.)

A nurse is assessing a client during a prenatal visit. The nurse takes the client's temperature and notes that the temperature is 99.2° F. Which nursing action is appropriate?

Document the temperature. (The normal temperature during pregnancy is 98° to 99.6° F (36.2° to 37.6° C). A temperature above this level suggests infection that might require medical management. Options 1, 3, and 4 are unnecessary.)

The nurse is providing instructions to a pregnant client with heartburn regarding measures that will alleviate the discomfort. The nurse instructs the client to:

Drink decaffeinated coffee and tea. (Spices tend to trigger heartburn. Caffeine, like spices, may cause heartburn and needs to be avoided. Eating smaller, more frequent portions is preferable to eating three large meals to control heartburn. Lying down after meals is likely to lead to the reflux of stomach contents and cause heartburn. Salt leads to the retention of fluid.)

A client asks a nurse to describe how her baby is developing. The nurse bases the response on the knowledge that every organ system in the fetus is present by the end of which gestational week?

Eighth (At the end of the eighth week, all organ systems and external structures are present. )

During an office visit, a prenatal client with mitral stenosis states she has been under a lot of stress lately. During data collection the client questions everything the nurse does and behaves in an anxious manner. The appropriate nursing response or action at this time would be to:

Explain the purpose of the nurse's actions, and answer all questions. (For the prenatal cardiac client, stress should be reduced as much as possible. It is important to be certain the woman understands the purpose of any procedures so she does not worry unnecessarily. Options 1, 2, and 4 are nontherapeutic at this time. Explaining the purpose of nursing actions will assist in decreasing the stress level of the client.)

A pregnant client tells the nurse that she has been craving "unusual foods." On further data collection, the nurse discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Which of the following laboratory results indicates a physiological consequence of a result of this practice?

Hemoglobin 9.1 g/dL (Pica cravings often lead to iron deficiency anemia, resulting in a lowered hemoglobin. The other three laboratory values are within normal limits for the pregnant woman.)

A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tells the nurse that she is experiencing irregular contractions, and the nurse determines that the client is experiencing Braxton Hicks contractions. Which of the following nursing actions would be appropriate?

Instruct the client that these are common and may occur throughout the pregnancy. (Braxton Hicks contractions are irregular, painless contractions that occur throughout pregnancy, although many expectant mothers do not notice them until the third trimester. )

A nurse is reviewing the health care record of a pregnant client at 16 weeks of gestation. The nurse would expect documentation that the fundus of the uterus is noted at which area?

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

A pregnant client asks the nurse about the hormone that stimulates postpartum contractions. The nurse tells the client that the primary hormone that stimulates postpartum contractions is:

Oxytocin (Oxytocin stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Prolactin stimulates the secretion of milk, called lactogenesis. Progesterone stimulates the secretions of the endometrial glands and causes the endometrial vessels to become dilated and tortuous in preparation for possible embryo implantation. Testosterone is produced by the adrenal glands in the female and induces the growth of pubic and axillary hair at puberty.)

A 38-week gestational pregnant woman arrives at the emergency department. She reports the presence of bright red vaginal bleeding and denies the presence of any pain. Based on this information, the nurse determines that the client may be experiencing:

Placenta previa (The primary symptom in placenta previa is painless vaginal bleeding in the second or third trimester of pregnancy. Passage of the mucous plug appears pink or as blood-tinged mucus. A ruptured amniotic sac would include findings such as a watery vaginal drainage. Findings of abruptio placentae include dark red vaginal bleeding and abdominal pain.)

A nurse is caring for a pregnant client with a history of human immunodeficiency virus (HIV). Which problem has the highest priority for this client?

Potential for infection (Clients with HIV often show some evidence of immune dysfunction and may have increased vulnerability to infection. Although the client may need assistance with hygiene measures and may have difficulty tolerating activity, these are not the priority. Although imbalanced nutrition is a concern, infection is specifically related to HIV and is a priority.)

The client asks the nurse about the purpose of the placenta. The nurse plans to respond to the client, knowing that the placenta:

Provides an exchange of nutrients and waste products between the mother and the fetus (The placenta provides an exchange of nutrients and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and allows for fetal movement. The amniotic fluid also maintains the body temperature of the fetus.)

A nurse is collecting data from a client with placenta previa during an office visit. The nurse checks which of the following items as first priority?

Signs of fetal distress (Although all of the options may be assessed, the safety of the mother-infant dyad is the priority. Signs of fetal distress is a primary concern, although the information gained through the other assessments may ultimately affect the well-being of the fetus.)

The nurse working in a prenatal clinic reviews a client's chart and notes that the health care provider documents that the client has a gynecoid pelvis. The nurse understands that this type of pelvis is:

The most favorable for labor and birth (A gynecoid pelvis is a normal female pelvis, and it is the most favorable for successful labor and birth. An android pelvis would not be favorable 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. The platypelloid pelvis has a wide transverse diameter, but the anteroposterior diameter is short, thus making the outlet inadequate.)

The nurse is reviewing the health record of a pregnant client at 16 weeks' gestation. The nurse should expect to note documentation that the fundus of the uterus is located at which of the following areas?

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

A blood glucose measurement is performed on a pregnant client. The results indicate that her blood glucose is elevated. Which of the following would the nurse anticipate to be prescribed for the mother?

A 3-hour glucose tolerance test (A maternal blood glucose measurement is prescribed to screen for gestational diabetes. If it is elevated, a 3-hour glucose tolerance test is recommended to determine the presence of gestational diabetes. Options 1, 2, and 4 would not be prescribed based solely on the maternal glucose levels. Further follow-up would be implemented.)

A blood glucose measurement is performed on a pregnant client, and the results indicate that the blood glucose is elevated. Which should the nurse anticipate to be prescribed for the mother?

A 3-hour glucose tolerance test (A maternal glucose is prescribed to screen for gestational diabetes. If it is elevated, a 3-hour glucose tolerance test is recommended to determine the presence of gestational diabetes. Options 2, 3, and 4 would not be prescribed based solely on the maternal glucose levels. Further followup would be implemented.)

A nurse is instructing a pregnant client regarding dietary measures to promote a healthy pregnancy. The nurse instructs the client to consume an adequate intake of fluid on a daily basis. Which statement by the client indicates an understanding of the daily fluid requirement?

"I should drink 8 to 12 glasses of liquid in addition to my daily milk requirement." (The nurse should instruct the client to drink an adequate fluid intake on a daily basis to assist in digestion and in the management of constipation: 8 to 12 glasses of liquids (1500 to 2000 mL) in addition to the daily milk requirement are recommended every day. This fluid should be water or fruit and vegetable juices rather than carbonated soft drinks or caffeinated beverages.)

A pregnant client who is anemic tells the nurse that she is concerned about what her baby's condition will be following delivery. Which nursing response would best support the client?

"The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure that you are providing the best nutrition and growth potential." (The effects of maternal iron deficiency anemia on the developing fetus and neonate are unclear. In general, it is believed that the fetus will receive adequate maternal stores of iron, even if a deficiency is present. Neonates of severely anemic mothers have been reported to experience reduced red cell volume, hemoglobin, and iron stores. Options 1 and 3 provide a false reassurance to the client. Option 2 will cause further concern in the client. Option 4 provides the most realistic support for the client and allows the nurse an opportunity to review the client's plan of care to clarify information and reassure the mother.)

A nurse shares with a pregnant client that the results of her rubella screening is positive. What is the nurse's response when asked by the client if it is safe for her 15-month-old toddler to receive the rubella vaccine?

"You are immune to the virus so it is safe for your toddler to receive the vaccine at this time." (A positive maternal titer further indicates that a significant antibody titer has developed in response to a prior exposure to Rubivirus, and immunity to the virus has been achieved so it is safe to be exposed as through contract with a newly vaccinated child. Children should receive their rubella immunization according to schedule (12 to 15 months of age).)

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 appropriate?

"You were wise to call. I will check your rubella titer screening results and we can identify immediately if 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. Rubella titer screening is a standard antenatal test for women during their initial screening. The results of this screening test need to be checked to determine if interventions are necessary. )

The nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student responds correctly by stating that which of the following are functions of amniotic fluid? Select all that apply.

1. Allows for fetal movement 2. Is a measure of kidney function 3. Surrounds, cushions, and protects the fetus 4. Maintains the body temperature of the fetus

A nursing instructor asks a student to list the functions of the amniotic fluid. The student responds correctly by stating that which of the following are functions of amniotic fluid? Select all that apply.

1. Allows for fetal movement 2. Is a measure of kidney function 3. Surrounds, cushions, and protects the fetus 4. Maintains the body temperature of the fetus (The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely, maintains the body temperature of the fetus, and helps assess kidney because it contains urine from the fetus. 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 nurse is collecting data from a client who suspects she is pregnant. The nurse is checking the client for probable signs of pregnancy. What are the probable sign(s) of pregnancy that the nurse should recognize? Select all that apply.

1. Ballottement 2. Chadwick's sign 3. Uterine enlargement 4. Braxton Hicks contractions (The probable signs of pregnancy include uterine enlargement, Hegar's sign (the compressibility and softening of the lower uterine segment that occurs at about week 6), Goodell's sign (the softening of the cervix that occurs at the beginning of the second month of pregnancy), Chadwick's sign (the violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (the rebounding of the fetus against the examiner's fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test that measures for human chorionic gonadotropin. Positive signs of pregnancy include a fetal heart rate that is detected by an electronic device (Doppler transducer) at 10 to 12 weeks' gestation and by a nonelectronic device (fetoscope) at 20 weeks' gestation; active fetal movements that are palpable by the examiner; and an outline of the fetus via radiography or ultrasound.)

A nurse is preparing to teach a pregnant client about the warning signs in pregnancy and prepares a list of the warning signs that indicate the need to notify the health care provider. Choose the warning signs that the nurse places on the list. Select all that apply.

1. Facial edema 2. Rapid weight gain 3. Visual disturbances 4. Generalized edema (Visual disturbances, rapid weight gain, and generalized or facial edema are warning signs in pregnancy. Braxton Hicks contractions are the normal, regular, painless contractions of the uterus that may occur throughout the 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.)

A nurse is collecting data on a client with severe preeclampsia. Choose the findings that would be noted in severe preeclampsia. Select all that apply.

1. Oliguria 4. Proteinuria 3+ 6. Blood pressure 168/116 mm Hg (Severe preeclampsia is characterized by blood pressure higher than 160/110 mm Hg, proteinuria 3+ or higher, and oliguria. Seizures (convulsions) are present in eclampsia and are not a characteristic of severe preeclampsia. Muscle cramps and contractions are not findings noted in severe preeclampsia, although the client is monitored for these occurrences.)

The nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. The nurse checks the client for which classic signs of preeclampsia? Select all that apply.

1. Proteinuria 2. Hypertension 4. Generalized edema (The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria.)

A clinic nurse is teaching a pregnant client about the warning signs in pregnancy and prepares a list of the warning signs that indicate the need to notify the health care provider. Which of the following would be included on the list? Select all that apply.

1. Visual disturbances 2. Rapid weight gain 3. Generalized or facial edema 5. Vaginal bleeding (Visual disturbances, rapid weight gain, and generalized or facial edema are warning signs in pregnancy. Braxton Hicks contractions are the normal irregular, painless contractions of the uterus that may occur throughout the pregnancy. Additional warning signs in pregnancy include vaginal bleeding, premature rupture of the membranes, preterm uterine contractions that are normal and regular, a change in or absence of fetal activity, severe headache, epigastric pain, persistent vomiting, abdominal pain, and signs of infection.)

A nurse is collecting data on a pregnant client and is preparing to auscultate the fetal heart sounds. The nurse prepares to use a fetoscope, knowing that fetal heart sounds can be heard with a fetoscope by which week of gestation?

18 to 20 weeks (Fetal heart sounds can be heard with a fetoscope by 18 to 20 weeks of gestation. Options 1, 2, and 3 are incorrect because the fetal heart sounds cannot be heard with a fetoscope at these gestational times.)

The nurse notes that the pulse rate of a client in the second trimester of pregnancy has increased since the last visit. What is the explanation for this increase?

A normal finding (Between 14 and 20 weeks, the pulse increases slowly, up 10 to 15 beats per minute, which lasts until term. Cardiac output and blood volume increase. Blood pressure decreases during the first half of pregnancy, returning to baseline in the second half of pregnancy. Although excitement may cause an increase in pulse rate, the likely cause is the combination of normal physiological changes that occur during pregnancy. The remaining options are not supported by the information given in the question.)

A client diagnosed with severe preeclampsia is on magnesium sulfate by continuous intravenous infusion. Which finding suggests to the nurse that the next dose of this medication should be held?

Absence of deep tendon reflexes (Adverse side effects with magnesium sulfate include central nervous system depression. The nurse monitors the client to ensure that the respiratory rate is greater than 13 breaths per minute, that the urine output is greater than 30 mL/hour, and that deep tendon reflexes are present. A decrease in blood pressure is a positive finding. The absence of deep tendon reflexes indicates the need to discontinue the infusion of this medication.)

A nurse is caring for a client experiencing a partial placental abruption. The client is uncooperative and is refusing any interventions until her husband arrives at the hospital. The nurse analyzes the client's behavior as likely the result of:

Acute anxiety and the need for support (Any of the situations identified in the options may contribute to the reason for the client's behavior, but the most likely reason is anxiety. Option 3 is the only option that supports the information identified in the question. The client may be anxious about the unknown effects of complications, and the presence of a support person while dealing with a crisis is crucial. There are no data in the question to support options 1, 2, and 4.)

A clinic nurse is reviewing the records of the pregnant clients that will be seen in the clinic. Which client profile presents the greatest risk for human immunodeficiency virus (HIV) infection?

An adolescent with multiple heterosexual contacts (Although all women are at risk for developing HIV during their reproductive years, it is believed that adolescents are particularly at risk because they engage in high-risk behaviors. )

A pregnant client has just been admitted to the hospital with severe preeclampsia. The nurse knows it is important to monitor for additional complications at this time. Part of the plan of care for this client should be to monitor for:

Any bleeding, such as in the gums, petechiae, and purpura (Bleeding is an early sign of disseminated intravascular coagulation (DIC), a complication of preeclampsia, and should be reported. Options 2, 3, and 4 are normal occurrences in the last trimester of pregnancy.)

A nurse instructs a pregnant client diagnosed with human immunodeficiency virus (HIV) to report immediately to the health care provider any early signs of vaginal discharge or perineal tenderness. What is the primary expected outcome for this intervention?

Assists in identifying infections that may need to be treated (The HIV-positive client may be further at risk for superimposed infections during pregnancy. Among these include Candida infections, genital herpes, and anogenital condyloma. Early reporting of symptoms may alert the members of the health care team that further assessment and testing are needed to diagnose and manage additional maternal and fetal physiological risks. The remaining options are benefits that can be experienced when complications such as infections are identified early.)

A client in the third trimester of pregnancy visits the clinic for a scheduled prenatal appointment. The client tells the nurse that she frequently has leg cramps, primarily when she is reclining. On the basis of the client's complaint, the nurse should first:

Check for signs of thrombophlebitis. (Leg cramps may be a result of compression of the nerves supplying the legs because of the enlarging uterus, a reduced level of diffusible serum calcium, an increase in serum phosphorus, or the presence of thrombophlebitis. In the pregnant client who complains of leg cramps, the nurse would first check for signs of thrombophlebitis and notify the registered nurse. If thrombophlebitis is not present, the nurse may be instructed to massage and place heat on the affected area, dorsiflex the foot until the spasm relaxes, or have the client stand on a cold surface. 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. Although the nurse may check for edema and assess the pedal pulses, these would not be the first actions.)

A pregnant client is seen in the health care clinic with reports of morning sickness. When the client asks the nurse about measures to relieve this situation, what is the nurse's appropriate suggestion?

Consume dry crackers before getting out of bed. (Some strategies for decreasing morning sickness are keeping crackers, melba toast, or dry cereal at the bedside to eat before getting up in the morning; eating smaller, more frequent meals; decreasing fats; and consuming adequate fluid between meals.)

A client who is 6 months pregnant is attending her first prenatal visit. On the first prenatal visit, the nurse notes that the client is gravida IV, para 0, aborta III. The client is 5 feet, 6 inches tall, weighs 130 pounds, and is 25 years old. She states, "I get really tired after working all day and can't keep up with my housework." Which factor in the above data would lead the nurse to suspect gestational diabetes?

Fetal demise (A previous history of unexplained stillbirths or miscarriages puts the client at high risk for gestational diabetes. Fatigue is a normal occurrence during pregnancy. A client at 5 feet, 6 inches tall, 130 pounds does not meet the criteria of 20% over ideal weight; therefore the client is not obese. To be at high risk for gestational diabetes, the maternal age should be greater than 30 years.)

A nurse is providing instructions to a pregnant client regarding the need to consume folic acid in the diet. The nurse determines that the client understands the instructions when the client states that it is necessary to include which of the following food items in the diet?

Green, leafy vegetables (Sources of folic acid include green, leafy vegetables, whole grains, fruits, liver, dried peas, and beans. The foods listed in options 1, 2, and 3 are not sources of folic acid.)

A nurse-midwife is performing an assessment on a pregnant client and is assessing the client for the presence of ballottement. The nurse who is assisting understands that the nurse-midwife will implement which to test for the presence of ballottement?

Initiate a sudden tap on the cervix. (Near mid-pregnancy, a sudden tap on the cervix during a vaginal exam may cause the fetus to rise in the amniotic fluid and then rebound to its original position. When the cervix is tapped, the fetus floats upward in the amniotic fluid. The examiner feels a rebound when the fetus falls down. Options 1, 3, and 4 are incorrect.)

A pregnant client asks the prenatal clinic nurse what the fetal period of development means? The nurse tells the woman that the fetal period is the:

Longest period of fetal development (The fetal period is the longest part of prenatal development. It begins 9 weeks after conception and ends with birth. All major systems are present in their basic form. The pre-embryonic period is the first 2 weeks after conception. Around the fourth day after conception, the fertilized ovum, now called a zygote, enters the uterus. The embryonic period of development extends from the beginning of the third week through the eighth week after conception. Basic structures of all major body organs are completed during the embryonic period.)

A nurse is providing instructions to a client about preterm labor. The nurse would do which of the following as the effective method for teaching the client to monitor for preterm uterine contractions?

Palpate for uterine contractions at the same time as the client. (Option 1 uses teaching and learning principles. It includes the most direct way to determine the level of client understanding. The client may not be able to read well. The client may not understand what to feel for with contractions and may answer only to please the nurse. A monitor would be cost prohibitive and does not give human feedback.)

A nurse is assisting in conducting a prenatal session with a group of expectant parents. The nurse tells the parents that the primary hormone that stimulates the secretion of milk is:

Prolactin (Prolactin stimulates the secretion of milk, called "lactogenesis." Testosterone is produced by the adrenal glands in the female and induces the growth of pubic and axillary hair at puberty. Oxytocin stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Progesterone stimulates the secretions of the endometrial glands, causing endometrial vessels to become highly dilated and tortuous in preparation for possible embryo implantation.)

The client is undergoing an amniocentesis at 16 weeks' gestation to detect the presence of biochemical or chromosomal abnormalities. The nurse instructs the client:

That the bladder must be full during the exam (Before 20 weeks' gestation, the bladder must be kept full during amniocentesis to support the weight of the uterus. After 20 weeks' gestation, the bladder should be emptied to minimize the chance of puncturing the placenta or fetus. Rho(D) immune globulin (RhoGAM) is administered to Rh-negative woman because of the risk of contact with the fetal blood during the exam. There are no fluid or food restrictions. Monitoring the fetal heart tones and the vital signs throughout and after the exam is an important intervention.)

A pregnant client is newly diagnosed as having gestational diabetes. She cries during the interview and keeps repeating, "What have I done to cause this? If I could only live my life over." Which client problem should initially direct nursing care at this time?

The client is blaming herself. (The client is putting the blame for the diabetes on herself. She is expressing fear and grief. There is no data in the question that indicates that the client lacks knowledge about diabetes treatment, is concerned about appearance, or is experiencing fetal distress.)

A nurse is gathering data from a prenatal client with heart disease. The nurse carefully evaluates vital signs, monitors for weight gain, and checks the fluid and nutritional status to detect complications caused by:

The increase in circulating volume (Pregnancy taxes the circulating system of every woman because both the blood volume and cardiac output increase. This is especially important to monitor in the client whose heart may not tolerate this normal increase. Hypertrophy may result in cardiac disease, but the outcome would be a decrease in contractility, not an increase. Options 3 and 4 are related to the fetus, not the prenatal client.)

A nurse is preparing to instruct a pregnant client about nutrition. The nurse plans to include which of the following in this client's teaching plan?

The nutritional status of the mother significantly influences fetal growth and development. (Poor nutrition during pregnancy can negatively influence fetal growth and development. Although pregnancy poses some nutritional risk for the mother, not all clients are at high risk. Calcium is critical during the third trimester but must be increased from the onset of pregnancy. Intake of dietary iron is usually insufficient for the majority of pregnant women, and iron supplements are prescribed routinely.)

A nurse is assisting in teaching a series of classes on maintaining a healthy pregnancy. The goal for the class is "The pregnant woman will verbalize measures that may prevent physical traumatic conditions distressing to the fetus." Based on this goal, which of the following would be a part of the teaching plan for this class?

Travel precautions and use of shoulder seat belts (Placental separation as a result of uterine distortion can occur from trauma, such as in car accidents and decreases or shuts off uteroplacental circulation. Partial placental separation will also result in fetal distress, with the amount of distress depending on the degree of separation. Complete separation leads to sudden severe fetal distress followed by fetal death. Use of the shoulder seat belt decreases the risk of placental separation by preventing the traumatic flexion of the woman's body from sharp braking or impact, if an accident occurs. Although options 1, 2, and 3 are important teaching points, they are not related to physical trauma affecting the fetus.)

A pregnant client is anxious to know the sex of the fetus and asks the nurse when she will be able to know. The nurse responds by telling the client that the sex of the fetus can usually be determined by:

Weeks 12 to 16 (By the end of the 12th week, the fetal sex can be determined by the appearance of the external genitalia on ultrasound. )

A nurse is collecting data from a client during the first prenatal visit. The client is anxious to know the sex of the fetus and asks the nurse when she will be able to know. The nurse responds to the client, knowing that the sex of the fetus can be visually recognizable as early as week:

12 (By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the sex of the fetus can be determined visually.)

A pregnant woman in the second trimester of pregnancy complains of constipation and describes the home care measures she is taking to relieve the problem. Which should the nurse determine is a harmful measure in preventing constipation?

Adding 1 tablespoon of mineral oil to a bowl of cereal daily (Mineral oil should not be used as a stool softener because it inhibits the absorption of fat-soluble vitamins in the body. Constipation should be treated with increased fluids (six to eight glasses per day) and a diet high in fiber. Increasing exercise is also an excellent way to improve gastric motility.)

A nurse is assigned to care for a pregnant client with a diagnosis of sickle cell anemia. The nurse plans care, knowing that which of the following problems should receive highest priority?

Dehydration (For the 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 the fetus, such as an interruption of blood flow to the respiratory system and placenta. Although options 1, 2, and 3 may be components of the plan of care at some point, fluid volume deficit is the priority.)

The pregnant woman complains of being awakened frequently by leg cramps. The nurse reinforces instructions to the client's partner and tells the partner to:

Dorsiflex the client's foot while extending the knee. (Leg cramps often occur when the pregnant woman stretches her leg and plantarflexes her foot. Dorsiflexion of the foot while extending the knee stretches the gastrocnemius muscle, prevents the muscle from contracting, and halts the cramping. )

A nurse is providing dietary instructions to a pregnant client with a history of lactose intolerance. The nurse would instruct the client to consume which best food item to ensure an adequate source of calcium in the diet?

Dried fruits (The best source of calcium is dairy products. Women with lactose intolerance need other sources of calcium because they are not able to consume dairy products. Calcium is present in dark green leafy vegetables, broccoli, legumes, nuts, and dried fruits. Spinach contains calcium, but it also contains oxalates that decrease calcium availability. Orange juice does not contain significant amounts of calcium unless fortified with calcium. Option 1 is a dairy product and cannot be eaten by a client who has lactose intolerance.)

A nurse is monitoring a client at risk for placental abruption. Which of the following is indicative of this complication?

Fetal distress (Signs of placental abruption include a tender, rigid abdomen; pain; severe, dark red vaginal bleeding; maternal shock (hypotension); and fetal distress. The other options are incorrect.)

A nurse is reviewing the laboratory results of a pregnant client and notes that the hemoglobin level is decreased. Physiological dilutional anemia is documented in the client's record by the health care provider. The nurse plans care, knowing that this type of anemia is a result of which situation?

Increased blood volume of the mother during pregnancy (During the later part of the first trimester, the blood volume of the mother increases more rapidly than blood cell production, leading to a decrease in the concentration of hemoglobin and erythrocytes. This is a normal process that causes a physiological anemia of pregnancy, or hemodilution. There is an increased metabolism of iron and maternal hemoglobin formation. The poor intake of iron-rich foods may cause an anemic condition, but physiological anemia of pregnancy occurs as a result of increased blood volume of the mother during pregnancy.)

A nurse is collecting data on a pregnant woman who is human immunodeficiency virus (HIV) positive during the 32nd gestational week. The nurse reviews the data and determines that which finding requires further follow up?

Increased shortness of breath and bilateral rales (HIV infection in a pregnant woman may cause both maternal and fetal complications. Fetal compromise can occur because of premature rupture of the membranes, preterm birth, or low birth weight. Potential maternal effects include an increased risk of opportunistic infections. Individuals in the later stages of HIV are further susceptible to other invasive conditions, such as tuberculosis and a wide variety of bacterial infections. The finding in option 2 can be indicative of an opportunistic infection and requires followup.)

During a prenatal visit of a client diagnosed with placenta previa, the health care provider defers doing a vaginal examination. The nurse understands that this examination is avoided in this situation because of what potential risk?

Initiating severe hemorrhage (The placenta is implanted low in the uterus with placenta previa, and cervical examination could cause the disruption of the placenta and initiate severe hemorrhage. The other options are also correct, but the greatest concern based on the information in the question is hemorrhage.)

A pregnant woman reports to the health care clinic complaining of loss of appetite, weight loss, and fatigue. Following an assessment, tuberculosis is suspected. A sputum culture is obtained and identifies the Mycobacterium tuberculosis in the sputum. The nurse provides instructions to the client regarding therapeutic management of tuberculosis and tells the client that:

Isoniazid (INH) plus rifampin (Rifadin) will be required for a total of 9 months. (More than one medication may be used to prevent growth of resistant organisms in the pregnant woman with tuberculosis. Treatment must continue for a prolonged time. The preferred treatment for the pregnant woman is daily isoniazid plus rifampin for a total of 9 months. Ethambutol is also added initially if drug resistance is suspected. Pyridoxine (vitamin B6) is often administered with isoniazid to prevent fetal neurotoxicity. The infant will be tested at birth and may be started on preventive isoniazid therapy. Skin testing should be repeated at 3 months on the infant, and isoniazid may be stopped if the skin test result remains negative. If the skin test result converts to positive, a full course of isoniazid would be given.)

A nurse is teaching a pregnant client about the warning signs in pregnancy that require the need to notify the health care provider. The nurse determines that further teaching is needed if the client states that it is necessary to call the health care provider if which of the following occurs?

Irregular, painless contractions (Visual disturbances, rapid weight gain, and generalized or facial edema are warning signs in pregnancy. Braxton Hicks contractions are the normal, irregular, painless contractions of the uterus that may occur throughout the 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 nurse caring for a client with abruptio placentae is monitoring the client for signs of disseminated intravascular coagulopathy (DIC). The nurse would suspect DIC if he or she observes:

Petechiae, oozing from injection sites, and hematuria (DIC is a state of diffuse clotting in which clotting factors are consumed, which leads to widespread bleeding. Platelet counts are decreased, because they are consumed by the process. Coagulation studies show no clot formation (clotting times are thus prolonged), and fibrin plugs may clog the microvasculature diffusely rather than in an isolated area.)

A 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 to:

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. Use of appropriate resources will assist the client to avoid emotional stress, thus reducing additional cardiac compromise during the last trimester.)

A nurse is teaching a pregnant client how to perform Kegel exercises. The nurse tells the client that the purpose of these exercises is to:

Strengthen the pelvic floor in preparation for delivery. (Kegel exercises will assist to strengthen the pelvic floor. Pelvic tilt exercises will help reduce backaches. Instructing a client to drink 8 ounces of fluids six times a day will help prevent urinary tract infections. Leg elevation will assist in preventing ankle edema.)

A pregnant client asks a nurse about the type of exercises that are allowable during the pregnancy. The nurse should instruct the client that the safest exercise to engage in is which of the following?

Swimming (Non-weight-bearing exercises are preferable to weight-bearing exercises. Exercises to avoid are shoulder standing and bicycling with the legs in the air because the use of 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 exercise such as swimming is allowable.)

The plan of care for a pregnant teen should include teaching regarding which of the following concerning dental care?

Tell the dental office staff that she is pregnant. (Baking soda may irritate the gums, which are more likely to bleed because of hormonal changes of pregnancy. Local anesthetics for minor dental work should not have adverse effects on the fetus. Option 4 is inaccurate information. The dental staff needs to know about the pregnancy so that care is taken during examinations and x-ray studies are avoided.)

A pregnant client is a gravida III, para 0, abortus II. She is placed on bedrest at home because of preterm labor. The nurse provides information to the husband, knowing that which of the following will assist to promote family adaptation?

Teaching the husband to perform passive range of motion and provide back rubs for his wife (Range-of-motion exercises will help maintain muscle tone during bedrest, and back rubs provide skin-to-skin contact and are comforting. The inclusion of the significant other promotes adaptation and decreases the sense of isolation. Option 4 will lead to guilt and maladaptation. The husband should not be expected to titrate medications. Kegel exercises are beneficial but will not provide the human-to-human contact that promotes family adaptation.)

The nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse tells the client that fetal circulation consists of:

Two umbilical arteries and one umbilical vein (Blood pumped by the fetus' heart leaves the fetus through two umbilical arteries. After the blood is oxygenated, it is then returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.)

A nurse is gathering data from a 16-year-old pregnant client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which statement by the client indicates an immediate need for further investigation?

"I don't like my face anymore. I always look like I have been crying." (Options 2, 3, and 4 are dealing with body image. Although these comments should not be ignored, the need for follow-up is not urgent. Option 1 is an implication of periorbital and facial edema, which could be indicative of gestational hypertension (GH). Because this is an adolescent who has not sought early prenatal care, she is at higher risk for the development of GH.)

A nonstress test is prescribed for a pregnant client, and the client asks the nurse about the procedure. Which of the following informative statements will the nurse provide to the client?

"An ultrasound transducer that records fetal heart activity is secured over the abdomen where the fetal heart is heard most clearly." (The nonstress test takes about 30 to 40 minutes. The test is termed "nonstress" because it consists of monitoring only; the fetus is not challenged or stressed by uterine contractions to obtain the necessary data. It is a noninvasive test, 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 is then secured to the maternal abdomen. Fetal heart activity and movements are recorded.)

A pregnant woman has tested positive for human immunodeficiency virus (HIV). The nurse reinforces information to the client about HIV and determines that additional counseling is necessary when the client states:

"Breast-feeding after delivery is best for my baby." (Breast-feeding is contraindicated if the mother is positive for HIV because the virus may be spread to the infant in the breast milk. HIV is not spread through casual contact, so holding, hugging, and sleeping with other family members is not prohibited. A newborn may test positive for HIV for up to 2 years after birth because of placental transfer of maternal antibodies. It is vital that the nurse ascertain that the client has correct knowledge regarding the transmission of the disease and precautions necessary to prevent the spread of HIV.)

A nurse is caring for a pregnant client who was diagnosed with acquired immunodeficiency syndrome (AIDS) and asks the nurse if she will be able to breast-feed the infant after delivery. Which response by the nurse is appropriate?

"Breast-feeding is contraindicated." (The woman with AIDS will need to know that breast-feeding is contraindicated but that she can provide all other care for her infant. Characteristically, the newborn is asymptomatic at birth, and signs and symptoms usually become obvious during the first year of life. No immunization is available for HIV.)

A young pregnant woman with diabetes mellitus has lost 10 pounds during the first 15 weeks of gestation. The client tells the nurse, "I do not eat regular meals." Based on the client's statement, the nurse determines that the best response would be which of the following?

"Can you tell me more about what you are eating?" ( It is important for the nurse to obtain additional information from the client. In option 2, the nurse is using the therapeutic communication tool of validation and clarification in order to obtain more information. The other options will block communication. Option 1 devalues the client and shows disapproval. Option 3 is avoiding the subject, and option 4 provides false reassurance.)

When collecting data on a pregnant client, the nurse includes which question to determine whether the client is at risk for toxoplasmosis parasite infection?

"Do you have any cats as house pets, and, if so, do you ever come in contact with their soiled kitty litter?" (Toxoplasmosis is a systemic, usually asymptomatic illness caused by the protozoal parasite. Humans acquire the infection from inadequately cooked meat, eggs, or milk or from ingesting or inhaling the oocyst stage of the parasite excreted in feline feces in contaminated soil or kitty litter. The remaining options are not related to this disease.)

A nursing student is assigned to care for an adolescent female client in the health care clinic, and the instructor reviews the menstrual cycle with the student. The instructor determines that the student understands the process of the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) if the student states:

"FSH and LH are released from the anterior pituitary gland." (FSH and LH are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the Graafian follicle, and production of progesterone. )

A pregnant client tells the nurse that she has been experiencing pain as a result of hemorrhoids. Which of the following statements by the client would identify the need for further teaching regarding the hemorrhoids?

"Hemorrhoids are caused by the changes in hormones during pregnancy. They will go away after the baby is born." (Hemorrhoids are varicosities and are most likely to be precipitated during pregnancy by the pressure of the growing fetus inside the abdominal cavity. Standing aggravates the problem. Dietary factors such as fluids and roughage, and the technique of manual reduction should be included in the plan of care. Hormonal changes are not a factor.)

During a routine prenatal visit, a client complains of gingivitis and gums that bleed easily with brushing. When assisting to plan the care for the client, the nurse includes a goal that addresses proper nutrition to minimize this problem. The nurse determines that goal achievement has occurred when the client states which of the following?

"I am eating fresh fruits and vegetables for snacks and for dessert each day." (Fresh fruits and vegetables will provide vitamins and minerals needed for healthy gums. Cracked-wheat bread may abrade the tender gums; drinking water with meals has no direct effect on gums; saltine crackers before arising helps decrease nausea.)

A pregnant client tests positive for hepatitis B virus (HBV). The nurse determines that the client understands about this infection when the client says:

"I am so glad that I can breast-feed my baby after she has been vaccinated." (Although HBV is transmitted in breast milk, once serum immune globulin has been administered, the mother may breast-feed without risk to the newborn.)

A nurse provides instructions to a client with mild preeclampsia on home care. The nurse evaluates that the teaching has been effective when the client states:

"I need to check my urine with a dipstick every day for protein and call the health care provider if it is 2+ or more." (Option 4 is a correct statement. It is still important to keep health care provider appointments to monitor for any other physical changes in the mother or baby. Blood pressure must be taken in the same arm, in a sitting position, every day to obtain a consistent and accurate reading. The weight must be checked at the same time each day under the following conditions to obtain reliable weights: client wearing the same clothes, after client voids, and before client eats breakfast.)

A nurse in the prenatal clinic is taking a nutritional history from a pregnant adolescent. Which statement by the client would alert the nurse to a potential concern regarding adequate nutritional intake during the pregnancy?

"I need to gain only ten pounds so that my baby will be small like I am." (Pregnant adolescents are at higher risk for complications than are other pregnant clients. Adolescents are often concerned about their body image. If weight is a major focus, the adolescent is more likely to restrict calories to avoid weight gain. Option 2 is the only response that suggests a possible concern. Options 3 and 4 indicate that the client will consume items that will help increase calcium intake. Option 1 expresses an attempt to consume required vegetables.)

During a prenatal visit, the nurse is explaining dietary management to a client with diabetes mellitus. The nurse determines that the teaching has been effective when the client states:

"I need to increase the fiber in my diet to control my blood glucose and prevent constipation." (An increase in calories is needed during pregnancy, but concentrated sugars should be avoided, because they may cause hyperglycemia. The fat intake should be 20% to 30% of the total calories. The client with diabetes needs about 50% to 60% of her caloric intake from carbohydrates and about 12% to 20% from protein. High-fiber foods will control blood glucose levels and prevent constipation.)

A client is pregnant, has a history of heart disease, and has been instructed on care at home. Which statement by the client would indicate that the client understands her needs?

"I should avoid stressful situations." (To avoid infections, visitors with active infections should not be allowed to visit the client. Stress causes increased heart workload. Too much weight gain causes an increase in body requirements and stress on the heart. Resting should be on the side to prevent vena cava syndrome (hypotensive syndrome) and to promote blood return)

A nurse is caring for a client diagnosed with preeclampsia. Which statement by the client suggests the need for more teaching regarding possible complications of preeclampsia?

"I should expect that my urine output will decrease." (Warning signs and symptoms of preeclampsia to be reported include decreased urinary output, headaches and blurred vision, abdominal pain, and a change in fetal movement, particularly a decrease. Constipation is not associated with preeclampsia.)

A maternity nurse is caring for a client who is admitted to the hospital with a diagnosis of gestational diabetes. This is the client's first pregnancy. Which statement by the client indicates a knowledge deficit regarding gestational diabetes?

"I shouldn't have eaten so many sweets before I became pregnant." (Gestational diabetes is not necessarily caused by eating too many sweets before pregnancy. Options 1 and 2 indicate a common normal response. Option 4 is an accurate statement. Option 3 is the only option that indicates a knowledge deficit.)

The client at 28 weeks' gestation is Rh negative and Coombs antibody negative. The nurse determines that the client understands what the nurse has taught her about Rh sensitization when the client states:

"I will tell the nurse at the hospital that I had RhoGAM during pregnancy." (As described in the question, it is accepted practice to administer Rho(D) immune globulin (RhoGAM) to an Rh-negative woman at 28 weeks' gestation, with a second injection within 72 hours of delivery. This prevents sensitization, which could jeopardize a future pregnancy. For subsequent pregnancies or abortions, the injections must be repeated, because the immunity is passive.)

Magnesium sulfate is prescribed for a client with severe preeclampsia. Which statement by the student nurse supports the need for further education regarding the action of this medication?

"It increases acetylcholine and blocks neuromuscular transmission." (Magnesium sulfate produces flushing and sweating as a result of decreased peripheral blood pressure; decreases the central nervous system responses and acts an anticonvulsant; decreases the frequency and duration of uterine contractions; and decreases acetylcholine, blocking neuromuscular transmission.)

A nursing student is conducting a clinical conference regarding the hormones related to pregnancy. The instructor asks the student about the function of thyroxine. Which statement by the student indicates an understanding of this hormone?

"It increases during pregnancy to stimulate basal metabolic rate." (Thyroxine increases during pregnancy to stimulate basal metabolic rates. Relaxin is the hormone that softens the muscles and joints of the pelvis. Prolactin is the primary hormone of milk production. Progesterone maintains uterine lining for implantation and relaxes all smooth muscle including the uterus.)

A perinatal client with a history of heart disease has been instructed on care at home. Which of the following statements if made by the client would indicate the need for further instructions?

"It is best to rest on my right side." (Stress causes increased cardiac workload. Too much weight gain causes an increase in body requirements and stress on the heart. To avoid infections, visitors with active infections should not be allowed to visit the client. It is best to rest on the left side to promote blood return.)

A nursing instructor asks a nursing student to describe the process of quickening. Which statement by the student indicates an understanding of this term?

"It is the fetal movement that is felt by the mother." (Quickening is fetal movement and is not perceived until the second trimester. Between 16 and 20 weeks of gestation, the expectant mother first notices subtle fetal movements that gradually increase in intensity. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus, known as "uterine souffle" and is due to the blood circulation to the placenta and corresponds to the maternal pulse. Braxton Hicks contractions are irregular, painless contractions that occur throughout pregnancy, although many expectant mothers do not notice them until the third trimester. A thinning of the lower uterine segment occurs about the sixth week of pregnancy and is called "Hegar's sign.")

The nursing instructor asks a nursing student to describe the process of quickening. Which of the following statements, if made by the student, indicates an understanding of this term?

"It is the fetal movement that is felt by the mother." (Quickening is fetal movement that appears usually at week 16 to 20, when the expectant mother first notices subtle fetal movements that gradually increase in intensity. A compressibility of the lower uterine segment occurs at about 6 weeks' gestation and is called Hegar's sign. Braxton Hicks contractions are irregular, painless contractions that may occur throughout pregnancy. A soft blowing sound that corresponds with the maternal pulse may be auscultated over the uterus; this is known as uterine souffle. This sound is the result of blood circulation to the placenta, and it corresponds with the maternal pulse. )

A nursing student is conducting a clinical conference regarding the hormones that are related to pregnancy, and the instructor asks the student about the function of progesterone. Which of the following responses, if made by the student, indicates an understanding of the function of this hormone?

"It maintains the uterine lining for implantation and relaxes all smooth muscle, including the uterus." (Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle, including the uterus. Relaxin is the hormone that softens the muscles and joints of the pelvis during labor. Thyroxine increases during pregnancy to stimulate basal metabolic rates, and prolactin is the primary hormone of milk production.)

A pregnant woman reports that she has just finished taking the prescribed antibiotics to treat a urinary tract infection. The mother expresses concern that her baby will be born with an infection. Which response would the nurse make to help reduce the maternal fears that the newborn will be born with an infection?

"Now that you have taken the medication as prescribed, we will continue to monitor you closely by repeating the urine culture before you leave today." (Symptomatic bacteriuria has been associated with an increased risk of neonatal sepsis following delivery. Appropriate antenatal care of a client with a urinary tract infection includes antibiotic treatment and follow-up repeat urine cultures. Option 3 is the only therapeutic response and is the response that identifies accurate information.)

The nursing instructor asks the nursing student about the physiology related to the cessation of ovulation that occurs during pregnancy. Which response by the student indicates an understanding of this physiological process?

"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, thus inhibiting the release of follicle-stimulating hormone and luteinizing hormone, which are necessary for ovulation.)

A 32-week gestational client with a diagnosis of severe preeclampsia is admitted to the maternity department. The client is alone and appears very anxious. Which statement by the nurse is therapeutic?

"Tell me about your concerns." (The client is apprehensive and the nurse needs to assist the client in exploring her feelings and concerns. The remaining options do not focus on the client's feelings. Additionally, there are no data to suggest the client is married.)

A client is scheduled for an amniocentesis and tells the nurse, "I'm not sure I should have this test done." Which response by the nurse is appropriate?

"Tell me what concerns you have." (The nurse needs to gather more data and assist the client in exploring her feelings about the test. Options 2, 3, and 4 are blocks to communication and are nontherapeutic nursing responses.)

A pregnant anemic client is concerned about her baby's condition following delivery. Which nursing response would best support the client?

"The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential." (The effects of maternal iron deficiency anemia on the developing fetus and neonate are unclear. In general, it is believed that the fetus will receive adequate maternal stores of iron, even if a deficiency is present. Neonates of severely anemic mothers have been reported to experience reduced red cell volume, hemoglobin, and iron stores. Option 4 provides the most realistic support for the client and allows the nurse an opportunity to review the client's plan of care to clarify information and reassure the mother.)

A pregnant client who is anemic tells the nurse that she is concerned about her baby's condition following delivery. Which nursing response would best support the client?

"The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential." (The effects of maternal iron deficiency anemia on the developing fetus and neonate are unclear. In general, it is believed that the fetus will receive adequate maternal stores of iron, even if a deficiency is present. Neonates of severely anemic mothers have been reported to experience reduced red cell volume, hemoglobin, and iron stores. Options 1 and 2 provide a false reassurance to the client. Option 3 will cause further concern in the client. Option 4 provides the most realistic support for the client and allows the nurse an opportunity to review the client's plan of care to clarify information and reassure the mother.)

The nurse has a teaching session with a malnourished client regarding iron supplementation to prevent anemia during pregnancy. Which of the following statements, if made by the client, would indicate successful learning?

"The iron is needed for the red blood cells." (A nutritional supplement that is commonly needed during pregnancy for the red blood cells is iron. Anemia of pregnancy is primarily caused by iron deficiency. Iron supplements usually cause constipation. Meats are an excellent source of iron. Iron for the fetus comes from the maternal serum.)

A contraction stress test is scheduled for the client. The woman asks the nurse about the test. The most accurate description of the test includes which of the following?

"The uterus is stimulated to contract by either small amounts of oxytocin (Pitocin) or by nipple stimulation." (A contraction stress test assesses placental oxygenation and function and determines the fetus' ability to tolerate labor as well as its well-being. The test is performed if the non stress test result is abnormal. During the stress test, 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 stimulated to contract, either by the administration of a dilute dose of oxytocin (Pitocin) or by having the mother use nipple stimulation, until three palpable contractions with a duration of 40 seconds or more during a 10-minute period have occurred. Frequent maternal blood pressure readings are performed, and the client is monitored closely while increasing doses of oxytocin are given. Leopold's maneuvers are performed to locate the position of the fetus.)

A nursing student is asked to describe the size of the uterus in a nonpregnant client. Which response by the student indicates an understanding of the anatomy of this structure?

"The uterus weighs about 2 ounces." (Before conception, the uterus is a small pear-shaped organ entirely contained in the pelvic cavity. Before pregnancy, the uterus weighs approximately 60 g (2 ounces) and has a capacity of about 10 mL (0.3 ounce). At the end of pregnancy, the uterus weighs approximately 1000 g (2.2 pounds) and has a sufficient capacity for the fetus, placenta, and amniotic fluid.)

A nursing student is asked to describe the size of the uterus in a nonpregnant client. Which of the following responses, if made by the student, indicates an understanding of the anatomy of this structure?

"The uterus weighs about 2 ounces." (Before conception, the uterus is a small, pear-shaped organ that is contained entirely in the pelvic cavity. Before pregnancy, the uterus weighs approximately 60 g (2 oz), and it has a capacity of about 10 mL (1/3 oz). At the end of pregnancy, the uterus weighs approximately 1000 g (2.2 lb), and it has a capacity that is sufficient for the fetus, the placenta, and the amniotic fluid.)

Which statement by a pregnant client who is human immunodeficiency (HIV) positive indicates her understanding of the risk to her newborn during delivery?

"There is a risk of transmission from HIV-positive mothers to their newborn, although the newborn may be asymptomatic at birth." (There is a risk of transmission of HIV to a newborn at the time of delivery if the pregnant woman is HIV positive. Newborns may not exhibit symptoms for 18 months or more. Therefore the remaining options are incorrect.)

A woman at 20 weeks of gestation calls the health care provider's office and speaks to a nurse. The client states that she is having subtle but persistent changes in her vaginal discharge, menstrual-like cramps, and diarrhea. Which of the following is the least helpful response to the client?

"This is an emergency; you should come to the clinic within the hour." (The woman should be instructed to lie on her side, drink fluids, and keep her bladder empty. This will decrease uterine activity and prevent uterine hypoxia. If the woman continues to have persistent uterine activity after 1 hour or counts four or more contractions in less than an hour, she should be seen for further evaluation)

A nurse working in a prenatal clinic receives a telephone call from a client at 22 weeks of gestation. The client reports some vaginal discharge and has started to experience menstrual-like cramps and diarrhea. Which response by the nurse indicates a lack of understanding of the implications of the client's symptoms?

"This is probably an emergency. Have someone drive you to a hospital now." (If a client experiences uterine activity, it may be helpful to have her lie on the left side and drink fluids to reduce uterine hypoxia and activity. It may also be helpful to keep the bladder empty. If the woman continues to have persistent uterine activity after 1 hour or counts four or more contractions in less than an hour, she should be seen for further evaluation. The information presented in the question does not represent an emergency at this time, but it requires further monitoring.)

A client is 8 weeks pregnant and has waves of nausea accompanied by vomiting throughout the day. Food odors consistently precipitate the nausea. Her husband has an important business dinner planned, and she is reluctant to attend because of the nausea and vomiting. This has placed a strain on the husband-wife relationship. Which of the following statements by the nurse indicates an understanding of the problem?

"You feel you are having difficulty fulfilling your role as a wife." (There are no data to support the fear that the wife will be left at home. Options 3 and 4 are examples of giving advice and do not lead to open communication with the pregnant woman. Option 1 reflects a feeling that the woman may be having. By identifying this feeling, the nurse provides the opportunity for further discussion.)

Abdominal ultrasonography is prescribed for a woman who is pregnant. The nurse provides information to the client regarding the procedure and makes which statement to the woman?

"You will be positioned on your back and turned slightly to one side with your head elevated." (The client is positioned on the back with the head and the knees supported by pillows. The client's head will be elevated, and the client will be turned slightly to one side to prevent supine hypotension. The procedure takes 10 to 30 minutes. A full bladder makes it easier for sound waves to reach the pelvic area, so the client should be instructed to drink 1 to 2 quarts of clear fluid 1 hour before the test. The client should not void until the ultrasound is obtained. Options 1, 2, and 3 are incorrect.)

A client in the first trimester of pregnancy arrives at the health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse provides a list of instructions for the client regarding management of care. Choose the instructions that the nurse places on the list. Select all that apply.

1. To note the color of blood on each perineal pad 2. To watch for the evidence of the passage of tissue 3. To note the quantity of blood on each perineal pad 4. To count the number of perineal pads used on a daily basis

During a prenatal visit, the nurse checks the fetal heart rate (FHR) of a client in the third trimester of pregnancy. The nurse determines that the FHR is normal if which of the following heart rates is noted?

150 beats per minute (Fetal heart rate depends on gestational age. It is normally 160 to 170 beats per minute during the first trimester, but it slows with fetal growth to 110 or 120 (low end) to 160 (high end) beats per minute near or at term.)

A pregnant client asks a nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the mother that fetal movements will be noted between:

16 and 20 weeks of gestation (Fetal movement, called "quickening," is not perceived until the second trimester. Between 16 and 20 weeks of gestation, the expectant mother first notices subtle fetal movements that gradually increase in intensity.)

A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the mother that fetal movements will be noted between:

16 and 20 weeks' gestation (Quickening is fetal movement that usually first occurs between 16 and 20 weeks' gestation. The expectant mother first notices subtle fetal movements during this time, and these gradually increase in intensity)

A nulliparous woman asks the nurse when she will feel fetal movements. The nurse responds by telling the woman that the first recognition of fetal movement will occur at approximately:

18 weeks of gestation (The first recognition of fetal movements, or "feeling life," by the multiparous woman may occur as early as the 14th to 16th week of gestation. The nulliparous woman may not notice these sensations until the 18th week of gestation or later. The first recognition of fetal movement is called "quickening." )

A client asks the nurse to describe how her developing baby will get enough blood and oxygen. The nurse responds that the fetal circulatory system accomplishes this task by which of the following? Select all that apply.

2. Carrying more oxygen on fetal hemoglobin than maternal hemoglobin 3. Making the fetal cardiac output higher per unit of body weight than the maternal cardiac output 4. Bypassing the fetal lungs to circulate oxygen rich blood 5. Using the fetus's beating heart to pump blood in the circulatory system (The fetal lungs do not function for respiratory gas exchange, so a special circulatory pathway, the ductus arteriosus, bypasses the lungs. A small amount of blood circulates through the resistant lung tissue, but the majority follows the path with less resistance through the ductus arteriosus into the aorta. The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: fetal hemoglobin carries 20% to 30% more oxygen than maternal hemoglobin; the hemoglobin concentration of the fetus is about 50% greater than that of the mother; and the fetal heart rate is 110 to 160 beats per minute, making the cardiac output per unit of body weight higher than that of an adult.)

A nurse is assisting in performing an assessment on a client who is at 32 weeks of gestation. The nurse measures the fundal height in centimeters and expects the findings to be which of the following?

32 cm (From 22 weeks until term, the fundal height measured in centimeters is roughly plus or minus 2 cm of the gestational age of the fetus in weeks. If the fundal height exceeds weeks of gestation, additional assessment is necessary to investigate the cause for the unexpected uterine size. If an unexpected increase in uterine size is present, it may be that the estimated date of delivery is incorrect and the pregnancy is more advanced than previously thought. If the estimated date of delivery is correct, it may be possible that more than one fetus is present.)

A nurse is providing instructions to a pregnant client with genital herpes about the measures that need to be implemented to protect the fetus. The nurse tells the client that:

A cesarean section will be necessary if vaginal lesions are present at the time of labor. (For women with active lesions, either recurrent or primary at the time of labor, delivery should be by cesarean section to prevent the fetus from being in contact with the genital herpes. The safety of acyclovir has not been established during pregnancy and should be used only for a life-threatening infection. Clients should be advised to abstain from sexual contact while the lesions are present. If this is an initial infection, they should continue to abstain until they become culture-negative because prolonged viral shedding may occur in such cases. Keeping the genital area clean and dry will promote healing)

When collecting data from a pregnant client at risk for disseminated intravascular coagulation (DIC), which of the following factors would the nurse consider being significant?

A client who is gravida II who has just been diagnosed with dead fetus syndrome; fetal demise occurred 2 months ago (Dead fetus syndrome is considered a risk factor for DIC. Hemorrhage is a risk factor with DIC; however, a loss of 450 mL is not considered hemorrhage. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large baby is not considered a risk factor for DIC)

The perinatal client is admitted to the obstetric unit during an exacerbation of a heart condition. When planning for the nutritional requirements of the client, the nurse would consult with the dietitian to ensure which of the following?

A diet that is high in fluids and fiber to decrease constipation (Constipation causes the client to use Valsalva's maneuver. This causes blood to rush to the heart and overload the cardiac system. The absence of weight gain is not recommended during pregnancy. Diets that are low in fluid and fiber cause a decrease in blood volume, which in turn deprives the fetus of nutrients. Too much sodium could cause an overload to the circulating blood volume and contribute to the cardiac condition.)

A nurse palpates the anterior fontanel of a neonate and notes that it feels soft. The nurse analyzes this data as indicative of:

A normal finding (The anterior fontanel is normally 2.5 to 5 cm in width and diamond shaped. It can be described as soft, which is normal, or full and bulging, which could indicate increased intracranial pressure. Conversely, a depressed fontanel could mean that the neonate is dehydrated.)

The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The nurse notes that the health care provider has documented the presence of Goodell's sign. The nurse determines that this sign is indicative of:

A softening of the cervix (During the early weeks of pregnancy, the cervix becomes softer as a result of pelvic vasoconstriction, which causes Goodell's sign. Cervical softening is noted by the examiner during a pelvic examination. Goodell's sign does not indicate the presence of fetal movement. Human chorionic gonadotropin is noted in maternal urine with a positive urine pregnancy test. A soft blowing sound that corresponds with the maternal pulse may be auscultated over the uterus; it is the result of blood circulating through the placenta. )

A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The health care provider has documented the presence of Goodell's sign, and the nurse determines that this sign is indicative of:

A softening of the cervix (In the early weeks of pregnancy, the cervix becomes softer as a result of pelvic vasoconstriction, which causes Goodell's sign. Cervical softening will be noted during pelvic examination by the examiner. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is due to blood circulation through the placenta. Human chorionic gonadotropin is noted in maternal urine in a urine pregnancy test. Goodell's sign does not indicate the presence of fetal movement.)

A client with type 1 diabetes mellitus in the first trimester of pregnancy is scheduled for a health care provider's visit. The client asks the nurse whether a change in the medication to treat the diabetes will occur. The nurse bases the response on which of the following?

A steady increase in insulin will be needed. (There is little change in insulin requirements during the first trimester of pregnancy. In the second and third trimesters, insulin requirements increase gradually, often doubling toward the end of pregnancy. Oral hypoglycemic medications pass through the placenta and may be teratogenic to the fetus. Intermediate- and short-acting insulins are usually prescribed together. Option 3 is the correct option.)

A nurse is collecting data from a client and is reviewing the client's health record to determine the risk for preterm labor. Which of the following findings would place the client at this risk?

A urinary tract infection (One risk factor for preterm labor is the presence of a genitourinary infection. Although the connection is not clearly understood, one hypothesis involves the release of prostaglandins by the pathogens, which may contribute to the initiation of contractions. Other risk factors for preterm labor include a multifetal pregnancy, which contributes to overdistention of the uterus; anemia, which decreases oxygen supply to the uterus; and age less than 15 years or first pregnancy older than the age of 35.)

Which of the following histories would place a maternity client at risk for uterine rupture?

Cesarean section birth (A client with a history of a previous cesarean birth is at most risk for uterine rupture. When a client has a cesarean delivery, an incision is made in the uterine wall. The site of the incision can produce a weakened area in the uterine wall. The conditions identified in options 2, 3, and 4 do not place the client at risk for uterine rupture.)

A nurse is instructing a pregnant client on dietary sources of iron. Which of the following food selections made by the client demonstrates an understanding of teaching?

Fresh spinach (Dietary sources of iron include lean meats, liver, shellfish, dark green, leafy vegetables, such as spinach, legumes, whole grains and enriched grains, cereals, and molasses.)

A pregnant client in the second trimester of pregnancy is admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which finding should the nurse expect to note if this condition is present?

Abdominal pain (Classic signs and symptoms of abruptio placentae include vaginal bleeding, abdominal pain, uterine tenderness and contractions. Mild to severe uterine hypertonicity is present. Pain is mild to severe and localized over one region of the uterus, or diffuse over the uterus, with a board-like abdomen. Painless vaginal bleeding and a soft, nontender uterus in the second or third trimester of pregnancy are signs of placenta previa.)

An assessment of a woman at 32 weeks' gestation indicates moderate fetal distress. What is the nurse's priority intervention?

Administer oxygen with a face mask at 7 to 10 L/min. (Administering oxygen will increase the amount of oxygen for transport to the fetus. This action is essential regardless of the cause of the distress. Although the remaining options may be needed at some point during the care of the client, they are not the priority.)

A hepatitis B screen is performed on a pregnant client, and the results indicate the presence of antigens in the maternal blood. Which of the following does the nurse anticipate to be prescribed?

Administration of immune globulin and vaccine in the infant soon after birth (A hepatitis B screen is performed to detect the presence of antigens in maternal blood. If antigens are present, the infant should receive immune globulin and a vaccine soon after birth. Options 1, 2, and 3 are incorrect actions or treatment measures.)

The nurse is collecting data from a pregnant client when the client asks the nurse about the purpose of the fallopian tubes. The nurse responds to the client, knowing that the fallopian tubes:

Are where fertilization occurs (Each fallopian tube is a hollow muscular tube that transports a mature oocyte for final maturation and fertilization. Fertilization typically occurs near the boundary between the ampulla and the isthmus of the tube. The vagina is the organ of copulation, and the fetus develops in the uterus. Estrogen is a hormone that is produced by the ovarian follicles, the corpus luteum, the adrenal cortex, and the placenta during pregnancy. Progesterone is a hormone that is secreted by the corpus luteum of the ovary, the adrenal glands, and the placenta during pregnancy. )

A nursing student is asked to identify the location of the isthmus of the uterus. The student correctly states that the isthmus is the:

Area between the corpus of the uterus and the cervix (The uterus has three divisions: the corpus, isthmus, and cervix. The isthmus is located between the corpus of the uterus and the cervix. The upper division is the corpus or the body of the uterus. The uppermost part of the uterine corpus, above the area where the fallopian tubes enter the uterus, is the fundus of the uterus. The cervix is the tubular "neck" of the lower uterus.)

A nurse is providing health care information to a pregnant client who is human immunodeficiency virus (HIV) positive. The nurse instructs the client that it is important to avoid alcohol and cigarettes during pregnancy and to get adequate rest primarily to:

Avoid further stress on the maternal immune system. (The use of alcohol and cigarettes during the pregnancy of an HIV-infected client, as well as not getting appropriate rest, can compromise the maternal immune system and interfere with medical treatments that may be in place. Collectively, such factors may place both the mother and fetus at additional risk during the pregnancy.)

A nurse is providing information about health care to a pregnant client who is positive for human immunodeficiency virus (HIV). The nurse instructs the client that it is important to avoid alcohol and cigarettes during pregnancy and to get adequate rest primarily to:

Avoid further stress on the maternal immune system. (The use of alcohol and cigarettes during the pregnancy of an HIV-infected client, as well as not getting appropriate rest, can compromise the maternal immune system. Collectively, such factors may place both the mother and fetus at additional risk during the pregnancy. Although options 1, 2, and 4 are goals of care, option 3 represents the primary management issue for the HIV-infected client.)

A client presents at her health care provider's office 10 weeks pregnant with her first pregnancy. Which of the following is a presumptive sign of pregnancy that the client might be expected to have?

Breast changes (Breast changes are a presumptive sign of pregnancy. A bluish discoloration of the vagina and cervix (Chadwick's sign) is a probable sign. Pigmentation changes of the face are not a sign of pregnancy, although they may occur with pregnancy.)

A client age 23 develops melasma during pregnancy. The nurse notes that the client has started wearing very heavy makeup. The client tells the nurse that she is fearful that her mate will reject her, and that she has decreased her social engagements drastically because of this change. The nurse determines that the client is experiencing which problem?

Concern about her appearance (Although the nurse might consider all of these problems initially, the information described in the question most clearly relates to concern about appearance. Anxiety is inaccurate because there is a physical focus for the problem: melasma. The client has decreased social engagements, but there is no indication that she has excluded all activities. There are insufficient data to support the inability to carry out expected roles.)

A nurse is instructing a maternity client how to keep a fetal activity diary. The nurse tells the client to:

Contact the health care provider if the baby's movements are fewer than 10 times in 2 hours. (Most healthy fetuses move at least 10 times in 2 hours. Slowing or stopping of fetal movement may be an indication that the fetus needs some attention and evaluation. In general, women are advised to count fetal movements for 30 minutes three times a day. The woman should lie on her left side during the procedure because it provides optimal circulation to the uterus-placenta-fetus unit. The time of day may affect fetal movement, which is lower in the morning and higher in the evening.)

A nurse is providing a teaching session to a group of adolescent pregnant clients and is discussing the importance of nutrition. The nurse includes which of the following in the discussion?

Describing the appropriate amount of weight gain required during the pregnancy (The developmental stage of the adolescent needs to be addressed when the nurse is providing instructions regarding nutrition during pregnancy. The adolescent should not be told to eliminate favorite foods and places to eat. This may cause the adolescent to rebel. Eating only when hungry could lead to a deficit in nutrients. The adolescent is more likely to follow suggestions when the nurse explains why the weight gain is important.)

A client who is 8 weeks pregnant calls the clinic and speaks to the nurse about complaints of nausea and vomiting every morning. To promote relief, the nurse suggests:

Eating crackers before arising (Some measures for decreasing morning nausea are keeping crackers, melba toast, or dry cereal at the bedside to eat before getting up in the morning; eating smaller, more frequent meals; decreasing fats in the diet; and consuming adequate fluid between meals, but not with meals.)

In the prenatal clinic, a nurse is gathering data from a new client for the health history information. What is the best way for the nurse to elicit correct responses to questions that refer to sexually transmitted infections?

Establish a therapeutic relationship between the nurse and pregnant client. (The initial data collection interview establishes the therapeutic relationship between the nurse and the pregnant woman. It is planned, purposeful communication that focuses on specific content. )

A nurse is reviewing the record of a pregnant client and notes that the health care provider has documented the presence of Chadwick's sign. The nurse determines that the hormone responsible for the development of this sign is which of the following?

Estrogen (The cervix undergoes significant changes following conception. The most obvious changes occur in color and consistency. In response to the increasing levels of estrogen, the cervix becomes congested with blood, resulting in the characteristic bluish color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy.)

A nurse is reviewing the record of a pregnant client and notes that the health care provider has documented the presence of Chadwick's sign. The nurse understands that the hormone responsible for the development of this sign is which of the following?

Estrogen (The cervix undergoes significant changes following conception. The most obvious changes occur in color and consistency. In response to the increasing levels of estrogen, the cervix becomes congested with blood, resulting in the characteristic bluish tinge that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy.)

When planning care for a woman with gestational hypertension (GH), the nurse plans to encourage which maternal behavior?

Expression of hope for a positive outcome (Hoping for a positive outcome is an appropriate coping mechanism. It is important to support an expression of hope by a client with a high-risk pregnancy as long as the hope is realistic (e.g., fetus is viable). Anticipatory grieving is not a positive adaptation for this client. Grieving should begin when a loss occurs. Delaying nursery preparations at home reflects a "expecting the worst" situation. Walking 1 to 2 miles daily is contraindicated for a woman with GH.)

A nurse-midwife is conducting a session on the process of fertilization with a group of nursing students. The nurse-midwife asks a student to identify the structure where fertilization of an ovum takes place. Which of the following, if identified by the student, indicates an understanding of this process?

Fallopian tube (Fallopian tubes, also called oviducts, are 8 to 14 cm long and are quite narrow. The fallopian tubes are a pathway for the ovum between the ovary and the uterus. Fertilization occurs in the fallopian tube.)

A primigravida client comes to the clinic and has been diagnosed with a urinary tract infection. She has repeatedly verbalized concern regarding safety of the fetus. Which of the following client problems does the nurse identify as important at this time?

Fear about the safety of the fetus (The primary concern for this client is safety of her fetus, not herself. Therefore the priority problem at this time is option 4. Option 3 is the client's diagnosis. Pain and altered tissue integrity may be seen in clients experiencing urinary tract infections, but the question includes no data to support either of the option)

A nurse is preparing a pregnant client for a transvaginal ultrasound exam. The nurse tells the client that she will:

Feel some pressure when the vaginal probe is moved (Transvaginal ultrasonography, in which a lubricated probe is inserted into the vagina, allows evaluation of the pelvic anatomy. A transvaginal ultrasound exam is well tolerated by most clients because it alleviates the need for a full bladder. The client is placed in a lithotomy position or with her pelvis elevated by towels, cushions, or a folded blanket. The procedure is not physically painful, although the woman may feel pressure as the probe is moved.)

A nurse is providing emotional support to a client who experienced a spontaneous abortion. The nurse can best assist the client by planning care that focuses on which of the following psychosocial issues?

Feelings of guilt are often associated with grief. (Nurses must consider the psychological needs of the family experiencing spontaneous abortion. Grief often includes feelings of guilt. The grieving process is individual and may last a year or longer. It is not appropriate to focus on the client's ability to have other children. The amount of pain and discomfort is important, but this is a physiological concern.)

A nurse is assisting in performing a prenatal examination on a client in the third trimester of pregnancy. The primary health care provider performs Leopold's maneuvers on the client. The nurse understands that the first maneuver will assess for which of the following?

Fetal engagement (The first maneuver is to determine the contents of the fundus (either fetal head or breech) and thereby the fetal lie and presentation. The third maneuver can determine whether the fetus is engaged in the pelvis. Leopold's maneuvers should not be performed during a contraction. Placenta previa is diagnosed by ultrasonography, not by palpation.)

A primipara is being evaluated in the clinic during her second trimester of pregnancy. Which of the following would indicate an abnormal physical finding that necessitates further testing?

Fetal heart rate of 180 beats per minute (The fetal heart rate depends on the gestational age. It is 160 to 170 beats per minute during the first trimester, and it slows with fetal growth to approximately 120 to 160 beats per minute. Options 1, 2, and 3 are normal expected findings.)

A pregnant woman visiting a health care clinic for the first prenatal visit hears the health care provider discuss the preembryonic period of development with the nurse. The woman asks the nurse what this means. The nurse tells the woman that the preembryonic period is the:

First 2 weeks of fetal development following conception (The preembryonic period is the first 2 weeks after conception. Around the fourth day after conception, the fertilized ovum, now called a zygote, enters the uterus. The embryonic period of development extends from the beginning of the third week through the eighth week after conception. Basic structures of all major body organs are completed during the embryonic period. The fetal period is the longest part of prenatal development. It begins 9 weeks after conception and ends with birth. All major systems are present in their basic form.)

A nurse is reading the health care provider's (HCP) documentation regarding a pregnant client and notes that the HCP has documented that the client has a platypelloid pelvic shape. The nurse understands that this pelvic shape is:

Flat and nonfavorable for a vaginal birth (The platypelloid pelvic shape is flattened with a wide, short oval shape and is a nonfavorable shape for a vaginal birth. A gynecoid pelvic shape is rounded with a wide pubic arch and is the most favorable pelvic shape for a vaginal birth. An anthropoid pelvic shape is long, narrow, and oval. It is not as favorable a shape for a vaginal birth as the gynecoid pelvic shape; however, it is a more favorable pelvic shape than the platypelloid or android. The android pelvic shape is wedge-shaped and narrow and is a nonfavorable shape for a vaginal birth.)

The nurse is collecting data during the admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks, and she tells the nurse that she does not have a history of any type of abortion or fetal demise. The nurse would document the GTPAL for this client as:

G = 2, T = 1, P = 0, A = 0, L = 1 (Pregnancy outcomes can be described with the GTPAL acronym: G = gravidity (number of pregnancies); T = term births (number born after 37 weeks); P = preterm births (number born before 37 weeks' gestation); A = abortions/miscarriages (number of abortions/miscarriages); L = live births (number of live births or living children). Therefore, a woman who is pregnant with twins and who already has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of preterm births is 0, and the number of term births is 1. The number of abortions is 0, and the number of live births is 1.)

The nurse is collecting data during the admission assessment of a client who is pregnant with triplets. The client also has a 3-year-old child who was born at 39 weeks' gestation. The nurse would document which gravida and para status on this client?

Gravida II, para I (Gravida is a term that refers to a woman who is or who has been pregnant, regardless of the duration of the pregnancy. Parity is a term that means the number of births after 20 weeks' gestation; it does not reflect the number of fetuses or infants. )

A pregnant client is positive for the human immunodeficiency virus (HIV). Based on this information, the nurse determines that:

HIV antibodies are detected on the enzyme-linked immunosorbent assay (ELISA) test. (Diagnosis depends on serological studies to detect HIV antibodies. The most commonly used test is the ELISA test. Options 1 and 4 are incorrect because HIV occurs primarily through the exchange of body fluids. Option 3 is incorrect. A neonate born to an HIV-positive mother is at risk of developing this infection. )

A prenatal client diagnosed with anemia has come to the clinic. After reviewing the client's health record, the nurse notes that the laboratory values indicate low hemoglobin and hematocrit levels. Which of the following problems do the data best support?

High risk for infection (Women with anemia have a higher incidence of puerperal complications such as infection than do pregnant women with normal hematological values. No data in the question support options 1, 2, or 3.)

A nurse reviews the antenatal history of a client in early labor. The nurse recognizes that which factor noted in the history presents the greatest potential for causing neonatal sepsis following delivery?

History of substance abuse during this pregnancy (Risk factors for neonatal sepsis can arise from maternal, intrapartal, or neonatal conditions. Maternal risk factors before delivery include low socioeconomic status, poor prenatal care and nutrition, and a history of substance abuse during pregnancy. Premature rupture of the membranes or prolonged rupture of membranes greater than 18 hours before birth is also a risk factor for neonatal acquisition of infection.)

A nurse is assisting in developing a teaching plan for a pregnant client with diabetes mellitus. Which instruction is the priority for this client?

How to check for signs of hypoglycemia and the required treatment (In diabetes mellitus, the pancreas does not produce enough insulin for necessary carbohydrate metabolism. The physiological changes of pregnancy drastically alter insulin requirements. Pregnant diabetic clients should be taught to monitor themselves for hypoglycemia to minimize potential maternal and fetal effects that result from hypoglycemia. Testing for proteinuria is important for the mother with gestational hypertension. Management of preterm bleeding is taught to the mother with placenta previa. Managing the discomforts of early labor is important for all pregnant women.)

A client calls the health care provider's office to schedule an appointment because a home pregnancy test was performed and the results were positive. The nurse determines that the home pregnancy test identified the presence of which of the following in the urine?

Human chorionic gonadotropin (hCG) (In early pregnancy, hCG is produced by trophoblastic cells that surround the developing embryo. This hormone is responsible for positive pregnancy tests. )

A nurse is collecting data on a client who is pregnant with twins. Which of the following signs would alert the nurse to a potential problem specifically related to the twin pregnancy?

Hypertension (The mother with a multiple-gestation pregnancy is at a higher risk for preeclampsia than if she had a singleton pregnancy. Mother should be monitored for signs and symptoms of preeclampsia and preterm labor. A classic sign of preeclampsia is hypertension. An elevated blood glucose level and Rh sensitization are concerns but are not unique to a multiple pregnancy. Uterine size may be large for gestational age in a multiple-gestation pregnancy.)

A nurse is assigned to care for a pregnant client being admitted to the nursing unit. Laboratory and diagnostic studies have confirmed a diagnosis of gestational trophoblastic disease (hydatidiform mole). The nurse collects data on the client and reviews the results of the laboratory and diagnostic studies, knowing that which of the following is an unassociated finding with this diagnosis?

Hypotension (The most common signs and symptoms of gestational trophoblastic disease include elevated levels of HCG, vaginal bleeding, larger than normal uterus for gestational age, failure to detect fetal heart activity even with sensitive instruments, excessive nausea and vomiting, and early development of gestational hypertension. An elevated blood pressure would also be noted.)

During the antenatal period of a client diagnosed with the human immunodeficiency virus (HIV), the nurse weighs and plots the weight gain pattern routinely and discusses the findings. The primary purpose of this action is to:

Identify appropriate fetal development. (Pregnant HIV positive clients are at risk for alterations in nutrition, especially less than body requirements. Plotting weight gain patterns throughout pregnancy will help support adequate fetal development while reassuring the client that a safe environment is being promoted for her developing fetus. The remaining options are not specific to this client.)

A nurse is collecting data from a pregnant client and is preparing to take the client's blood pressure. The nurse positions the client:

In a sitting position (Because position affects blood pressure in the pregnant woman, the method for obtaining blood pressure should be standardized as much as possible. Blood pressure should be obtained with the client in the sitting position with the arm supported in a horizontal position at heart level. Options 1, 2, and 3 are incorrect, and these positions may cause physiological stress that will affect the blood pressure.)

A nurse is collecting data on a pregnant client and is preparing to take the client's blood pressure. The nurse positions the client:

In a sitting position (Because position affects blood pressure in the pregnant woman, the method for obtaining blood pressure should be standardized as much as possible. The blood pressure should be obtained in the sitting position with the arm supported in a horizontal position at heart level.)

A maternity nurse is providing an inservice educational session to nursing students regarding the process of conception. The nurse determines that a nursing student understands this process if the student states that fertilization of a mature ovum occurs in which of the following areas?

In the distal third of the fallopian tube (The mature ovum is transported through the fallopian tube by the muscular action of the tube and the movement of the cilia within the tube. Fertilization normally occurs in the distal third of the fallopian tube near the ovary. The ovum, fertilized or not, enters the uterus about 3 days after its release from the ovum. The other options are incorrect.)

A nurse in a prenatal clinic is teaching a group of pregnant clients about physiological adaptations during pregnancy. Which statement accurately describes the normal cardiovascular symptom experienced during pregnancy?

Increase in pulse (Between 14 and 20 weeks, the pulse increases slowly, up 10 to 15 beats from normal, which lasts until term. Cardiac output and blood volume increase. Blood pressure decreases in the first half of pregnancy, returning to baseline in the second half.)

A nurse in a prenatal clinic is teaching a group of pregnant clients about anemia. Which statement is accurate about the cause of physiological anemia of pregnancy or hemodilution?

Increased blood volume of the mother (During the latter part of the first trimester, the blood volume of the mother increases rapidly, more rapidly than blood cell production, leading to a decrease in the concentration of hemoglobin and erythrocytes. This is a normal process that causes a physiological anemia of pregnancy, or hemodilution. There is an increased metabolism of iron and maternal hemoglobin formation. The increased demand for iron is not a factor in the development of physiological anemia.)

The nurse is reviewing the laboratory results of a pregnant client and notes that the hemoglobin level is decreased. Physiological dilutional anemia is documented in the client's record by the health care provider. The nurse plans care, knowing that this type of anemia is a result of which situation?

Increased blood volume of the mother during pregnancy

A client is seen in the health care clinic for complaints of vaginal bleeding and mild abdominal cramping. On further data collection, the nurse notes that the client's last menstrual period was 10 weeks ago. The client reports that a home pregnancy test was performed and the results were positive. On physical examination, it is noted that the client has a dilated cervix. The nurse understands that the client is at risk for which type of abortion?

Inevitable (An inevitable abortion is a termination of pregnancy that cannot be prevented. Moderate to severe bleeding with mild abdominal cramping and cervical dilation is present. An incomplete abortion presents with heavy bleeding, severe cramping, cervical dilation, and passage of large clots. A threatened abortion presents with slight to moderate bleeding and intermittent cramping, but no dilation. A septic abortion presents with bleeding with odor, cervical dilation, and fever. Cramping may be present.)

A nurse is teaching a pregnant woman about the physiological effects and hormone changes that occur in pregnancy. The woman asks the nurse about the purpose of estrogen. The nurse bases the response on which of the following purposes of estrogen?

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 woman about the physiological effects and hormone changes that occur during pregnancy. The woman asks the nurse about the purpose of estrogen. The nurse bases the response on which of the following purposes of estrogen?

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 it 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. Human chorionic gonadotropin prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.)

A pregnant client in the prenatal clinic states that her last menstrual period (LMP) began April 5 and ended April 12. According to Nägele's rule, what would be the estimated date of delivery (EDD)?

January 12 (Nägele's rule is a noninvasive method of calculating the EDD as follows: subtract 3 months, add 7 days to the first day of the LMP, and add 1 year as appropriate. This is based on the assumption that the cycle is 28 days. April 5 plus 7 days minus 3 months is January 12.)

The client arrives at the prenatal clinic for her first prenatal assessment. The client tells the nurse that the first day of her last menstrual period was October 20, 2012. Using Nägele's rule, the nurse determines the estimated date of birth to be:

July 27, 2013 (The accurate use of Nägele's rule requires that the woman have a regular 28-day menstrual cycle. Subtract 3 months from the first day of the last menstrual period, add 7 days, and then adjust the year as appropriate. In this case, the first day of the LMP was October 20, 2012. When you subtract 3 months, you get July 20, 2012. If you add 7 days, you get July 27, 2012. Add 1 year to this, and you get the estimated date of birth: July 27, 2013.)

A nurse is reviewing the health care record of a pregnant client at 16 weeks' gestation. The nurse would expect documentation that the fundus of the uterus is noted at which of the following areas?

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

A prenatal client has acquired the sexually transmitted infection, condyloma acuminatum (human papillomavirus). When assisting in planning care, which of the following treatments would the nurse consider to be safe for this maternity client?

Laser therapy (Laser therapy is the most effective method of treatment for this disorder that is considered safe for pregnancy. Medications for the disease are considered toxic to the fetus. The primary neonatal effect of the virus is respiratory or laryngeal papillomatosis. The exact route of perinatal transmission is unknown)

The client is in her second trimester of pregnancy. She complains of frequent low back pain and ankle edema at the end of the day. The nurse recommends which measure to help relieve both discomforts?

Lie on the floor with the legs elevated onto a couch or padded chair, with the hips and knees at a right angle. (The position described in option 4 will produce the posture of the pelvic tilt while countering gravity as the force that leads to the edema of the lower extremities.)

A nurse is teaching a pregnant woman about the physiological effects and hormone changes that occur in pregnancy, and the woman asks the nurse about the purpose of progesterone. The nurse tells the woman that the purpose of progesterone is to:

Maintain the uterine lining for implantation. (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 and is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. Estrogen stimulates uterine development to provide an environment for the fetus, and stimulates the breasts to prepare for lactation.)

A nurse is assisting in conducting a childbirth class and is instructing pregnant women about the method of effleurage. The nurse instructs the woman to perform the procedure by:

Massaging the abdomen during contractions using both hands in a circular motion (Effleurage is massage of the abdomen during contractions. Women learn to do effleurage using both hands in a circular motion. Progressive relaxation involves contracting and then consciously releasing different muscle groups. Neuromuscular disassociation helps the woman relax her body even when one group of muscles is strongly contracted. In this procedure the woman contracts an area such as an arm or leg then concentrates on letting tension goes from the rest of the body. Touch relaxation helps the women to learn to loosen taut muscles when they are touched by her partner.)

A nurse is assisting in conducting a prepared childbirth class and is instructing pregnant women about the method of effleurage. The nurse instructs the women to perform the procedure by:

Massaging the abdomen during contractions using both hands in a circular motion (Effleurage is massage of the abdomen during contractions. Women learn to do effleurage using both hands in a circular motion. Progressive relaxation involves contracting and then consciously releasing different muscle groups. Neuromuscular disassociation helps the woman relax her body even when one group of muscles is strongly contracted. In this procedure, the woman contracts an area such as an arm or leg then concentrates on letting tension go from the rest of her body. Touch relaxation helps the woman to learn to loosen taut muscles when she is touched by her partner.)

A nurse is collecting data from a client who is pregnant with twins. The nurse understands that which of the following complications is likely associated with a twin pregnancy?

Maternal anemia (Maternal anemia occurs in a client pregnant with twins because the maternal system is nurturing more than one fetus. Preterm labor, rather than postterm labor is likely to occur. Hydramnios may be associated with a twin pregnancy as a result of increased renal perfusion from cross-vessel anastomosis with monozygotic twins. Option 4 is not a complication of a twin pregnancy.)

A nurse is told that a prenatal client is at risk for placental abruption. The nurse expects to note which risk factor documented in the client's record?

Maternal hypertension (Maternal hypertension is a risk factor associated with placental abruption. This factor leads to degenerative changes in the small arteries that supply the intervillous spaces of the placenta. This results in thrombosis, causing retroplacental hematoma and leading to placental separation. Options 1, 2, and 4 are not associated risk factors. )

A nurse is caring for a prenatal client who is at risk for placental abruption. Which risk factor documented in the client's record would support this diagnosis?

Maternal hypertension (It is possible that placental abruption can result from maternal hypertension, which causes degenerative changes in the small arteries that supply intervillous spaces. This results in thrombosis, causing a retroplacental hematoma and leading to placental separation. Options 1, 3, and 4 are not specific risk factors for placental abruption.)

A nurse encourages the childbearing woman diagnosed with human immunodeficiency virus (HIV) HIV to avoid alcohol and cigarettes during pregnancy and to obtain adequate rest. Which outcome is specific to this client?

Minimize the potential for developing infections. (The pregnant client with HIV needs to avoid practices that can compromise the maternal immune system and interfere with medical treatments that may be in place. Collectively, such practices may place both the mother and fetus at additional risk during the pregnancy. The remaining options are not as specific to the care of this client.)

A nurse is assigned to care for a client admitted with severe preeclampsia. What is the priority nursing intervention for this client?

Minimizing the client's exposure to external stimuli (The client with severe preeclampsia is kept on complete bedrest in a quiet environment. External stimuli such as lights, noise, and visitors that may precipitate a seizure should be kept to a minimum. 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. Food and fluid are not restricted unless prescribed by the care provider.)

A nurse assigned to care for a client with mild preeclampsia would anticipate which specific nursing intervention for this client?

Monitoring fetal movement (A client with mild preeclampsia can be managed at home. The expectant mother is asked to keep a record of fetal movements. Bedrest with bathroom privileges is prescribed. Urine is checked for protein. A blood glucose test is not necessary. The client usually follows a regular diet that does not restrict fluids.)

A nurse is providing information to a pregnant woman about food items high in folic acid. Which of the following mid-afternoon snacks should be recommended to supply folic acid?

Nuts and green, leafy vegetables (Folic acid is needed during pregnancy for healthy cell growth and repair. A pregnant woman should have at least four daily servings of foods rich in folic acid. The food items in option 3 contain folic acid.)

A 15-year-old client who is pregnant will be treated by a dermatologist for acne. The nurse understands that which of the following treatments for acne will likely be avoided with this client?

Oral tetracycline hydrochloride (Tetracycline is avoided during pregnancy because it may cause discoloration of the child's teeth when they erupt.)

A nurse is working with a pregnant client regarding how to identify the existence of preterm contractions. The nurse plans to use which strategy as the effective teaching method?

Palpate for uterine contractions at the same time as the client. (Option 3 is correct because it most fully uses teaching and learning principles. It provides for verification of whether the client can perform the skill, and gives immediate feedback about the client's level of understanding. A verbal description may be useful but does not provide for verification that the skill has been learned. Application of a fetal monitor is unnecessary and is more costly and time-consuming. Providing written material is incorrect because providing written material does not guarantee that the client has learned the skill.)

A nurse is providing instructions to a pregnant woman regarding measures that will strengthen the perineal floor muscles. The nurse instructs the client to:

Perform Kegel exercises in 10 repetitions, three times per day. (Kegel exercises strengthen the pelvic floor. Option 1 relates to hydration that is important for normal physiological body functioning. )

A nursing instructor asks a nursing student to describe the procedure for relieving an airway obstruction on an unconscious pregnant woman at 8 months' gestation. The student describes the procedure correctly if the student states to:

Place a rolled blanket under the right abdominal flank and hip area. (To relieve an airway obstruction on an unconscious woman in an advanced stage of pregnancy, the woman is placed on her back. A wedge, such as a pillow or rolled blanket, is placed under the right abdominal flank and hip to displace the uterus to the left side of the abdomen. )

A nurse is assisting a client who, at 38 weeks of gestation reports feeling dizzy, lightheaded, and nauseated when attempting to lie down on the examining table. Her skin is pale and is both cool and moist to the touch. What is the first nursing action?

Place a wedge pillow under the client's right side. (The symptoms suggest supine hypotension caused by compression of the aorta and inferior vena cava by the gravid uterus. Compression of these vessels is relieved by the placement of a wedge pillow under the woman's right side. Although the actions in the other options may be implemented, they are not the first action because they will not eliminate the problem.)

A nurse is assisting to care for a pregnant client in labor who will be delivering twins. The nurse prepares to monitor the fetal heart rates by:

Placing external fetal monitors so that each fetal heart rate is monitored separately (In a client with a multifetal pregnancy, each fetal heart rate is monitored separately)

A nurse is instructing a pregnant client in her first trimester about nutrition. The nurse would correct which of the following misunderstandings on the part of the client about nutrition during pregnancy?

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 for becoming malnourished. Calcium is critical during the third trimester but must be increased from the onset of pregnancy. Intake of dietary iron is usually insufficient for the majority of pregnant women, and iron supplements routinely are encouraged. Good nutrition during pregnancy significantly and positively influences fetal growth and development.)

A maternity nurse is describing the ovarian cycle to a group of nursing students and asks a nursing student to identify the phases of the cycle. Which phase, if stated by the nursing student, indicates a need to further research this area?

Proliferative phase (The ovarian cycle consists of three phases: preovulatory, ovulatory, and luteal. The proliferative phase is a phase of the endometrial cycle.)

A nurse is planning interventions for counseling a maternal client newly diagnosed with sickle cell anemia. The nurse understands that the important psychosocial intervention at this time would be which of the following?

Provide emotional support. (Probably the most important of all nursing functions is providing emotional support to the client and family. Option 1 overwhelms the client with information while the client is trying to cope with the news of the disease. Option 2 is only appropriate if the client requests to be alone if not requested, the nurse is abandoning the client in time of need. Option 4 is nontherapeutic. Supportive therapy allows the client to express feelings, explore alternatives, and make decisions in a safe, caring environment.)

A nurse is assisting in planning care to meet the emotional needs of a pregnant woman. Which of the following nursing interventions would be least likely to assist in meeting her emotional needs?

Providing the mother with pamphlets and booklets to read about the pregnancy (The woman's emotional needs can be met by providing regular opportunities for discussing aspects of her pregnancy and prenatal care, by using a caring and supportive approach, and by offering praise and reinforcement. The nurse also should discuss the emotional changes of pregnancy, family alterations, and changes in marital relationships that may occur. Option 4 does not provide a nurse-client interaction.)

A clinic nurse is planning care to meet the emotional needs of a pregnant woman. Which nursing intervention would least likely assist in meeting emotional needs?

Providing the mother with pamphlets and booklets to read about the pregnancy (The woman's emotional needs can be met by providing regular opportunities for discussing aspects of her pregnancy and prenatal care, by using a caring and supportive approach, and by offering praise and reinforcement. The nurse should also discuss the emotional changes of pregnancy, family alterations, and changes in marital relationships that may occur. Option 4 will least likely assist in meeting the emotional needs of the woman.)

A nurse is preparing to collect data on a client with a possible diagnosis of ectopic pregnancy. Which of the following would the nurse check first?

Pulse (The primary concern when ectopic pregnancy is suspected is the occurrence of bleeding and hypovolemic shock. Option 1 is the only assessment that would provide information related to this occurrence. An elevated pulse is an indicator of shock. The nurse should also monitor for decreasing hematocrit levels and pain. Options 2, 3, and 4 do not provide data that would indicate the occurrence of hypovolemic shock.)

A nurse is reinforcing the positive effects of breathing and relaxation techniques to a pregnant, cardiac client who has an 18-month-old child. What is the primary outcome for these interventions?

Reducing 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 strategies identified in this question would primarily reduce maternal stress and fatigue. Although the other options identify possible outcomes, they are not the primary purpose of these strategies.)

A client who consumes alcohol frequently is in the first trimester of pregnancy. What is the expected outcome when the nurse initiates interventions to assist the client to cease alcohol consumption?

Reducing the risk of teratogenic effects to developing fetal organs, tissues, and structures (The first trimester, "organogenesis," is characterized by the differentiation and development of fetal organs, systems, and structures. The effects of alcohol on the developing fetus during this crucial period depend not only on the amount of alcohol consumed, but also on the interaction of quantity, frequency, type of alcohol, and other drugs that may be abused during this period by the pregnant woman.)

During an initial prenatal visit, the nurse notes that the client's hemoglobin level is indicative of iron deficiency anemia. Which additional client data would also support this finding?

Reports of fatigue (Anemia is a common problem in pregnancy and is characterized by a hemoglobin level of less than between 10.5 and 11 g/dL. Iron deficiency anemia and folic acid deficiency are two common types of anemia that present a concern during pregnancy. Although fatigue may be seen in some pregnant women, its presence may reflect complications caused by decreased oxygen supply to vital organs, thus supporting the laboratory findings. The other options are normal observations during pregnancy.)

A pregnant client who has a positive pulmonary identification of the tuberculosis (TB) organism has been prescribed both isoniazid (INH) and rifampin (Rifadin). The nurse plans to implement which intervention?

Reviewing daily nutritional intake with the client (Social conditions placing pregnant women at risk for TB include poverty, crowded living conditions, and malnutrition. In the case of acute disease during the antenatal period, a 9-month course of isoniazid and rifampin is suggested. Follow-up sputum screenings and evaluations are essential to establish treatment effectiveness post-delivery. Teaching the client about the importance of an adequate nutritional intake needs to be included in the home care instructions. The remaining options do not contain correct information.)

A nurse is collecting data from a client on her first prenatal visit. Which factor indicates that the client is at risk for developing gestational diabetes during this pregnancy?

She has a history of chronic hypertension. (Known risk factors that increase the risk of developing gestational diabetes include obesity (more than 198 lb), chronic hypertension, family history of type 2 diabetes mellitus, previous birth of a large infant (more than 4000 g), and gestational diabetes in a previous pregnancy. Options 1, 3, and 4 are not risk factors.)

A nurse is teaching a pregnant client about the physiological effects and hormone changes that occur in pregnancy. The client asks the nurse about the purpose of estrogen. The nurse tells the client that estrogen:

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 and is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.)

A pregnant client with mitral valve prolapse is receiving anticoagulant therapy during pregnancy. The nurse collects data on the client and expects that the client will indicate that which of the following medications is prescribed?

Subcutaneous administration of heparin sodium 5000 units daily (Pregnant women with mitral valve prolapse are frequently given anticoagulant therapy during pregnancy because they are at greater risk for thromboembolic disease during the antepartum, intrapartum, and postpartum periods. Warfarin is contraindicated during pregnancy because it crosses the placental barrier, causing potential fetal malformations and hemorrhagic disorders. Heparin sodium, which does not cross the placental barrier, is safe to use during pregnancy and would be administered by the subcutaneous route. Terbutaline is indicated for preterm labor management only.)

A nurse is reviewing the health history of a pregnant client. Which of the following data, if noted in the client's health history, would indicate a risk for spontaneous abortion?

Syphilis (Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion. There is inconclusive evidence that genital herpes is a causative agent in abortion. Maternal age older than 40 years and diabetes mellitus are considered high risk factors in a pregnancy, increasing the risk of congenital malformations.)

During initial data collection of a client who is pregnant, the nurse notes that the laboratory report shows leukopenia, thrombocytopenia, anemia, and an elevated erythrocyte sedimentation rate. The nurse suspects human immunodeficiency virus (HIV). Which of the following laboratory studies would further support the presence of HIV?

T lymphocyte levels (HIV has a strong affinity for surface marker proteins on lymphocytes. This affinity of HIV for T lymphocytes leads to significant cell destruction. Angiotensin is produced in the kidney. Glomerular filtration rate indicates kidney function. Platelet count is important and may be an indicator of HIV, but this laboratory test already has been identified in the data of the question.)

A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tells the nurse that she is experiencing irregular contractions. The nurse determines that the client is experiencing Braxton Hicks contractions. Based on this finding, which nursing action is appropriate?

Tell the client that these are common and they may occur throughout the pregnancy. (Braxton Hicks contractions are irregular, painless contractions that may occur intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy)

Which finding in the prenatal client supports the medical diagnosis of placental abruption?

Tender, rigid abdomen (Signs of placental abruption include tender, rigid abdomen, cramp-like pain that is moderate to severe, dark red vaginal bleeding, and maternal shock and fetal distress. The other options are not findings in placental abruption.)

A nurse is preparing a 36-year-old gravida II, para I pregnant client for an amniocentesis. She is at 16 weeks of gestation. Which of the following actions will the nurse take before the procedure to ensure the maintenance of fetal safety during the procedure?

Test the ultrasound equipment to ensure proper functioning. (Before 20 weeks of gestation, it is recommended to perform an amniocentesis with the bladder full. This pushes the uterus upward for better visualization. After week 20, the bladder is emptied before the test to minimize the risk of puncturing it during the test. The client does need to be taught about the signs and symptoms of labor because this action does not ensure fetal safety. The local anesthetic makes the insertion of the needle less painful but does not protect the fetus. The use of ultrasound to guide the procedure has greatly decreased the risk of fetal and placental damage during the procedure.)

A pregnant client is seen in the health care clinic and asks the nurse what causes the breasts to change in size and appearance during pregnancy. The nurse bases the response on which of the following?

The breast changes are a result of the secretion of estrogen and progesterone. (During pregnancy the breasts change in both size and appearance. The increase in size is a result of the effects of estrogen and progesterone. Estrogen stimulates the growth of mammary ductal tissue, and progesterone promotes the growth of lobes, lobules, and alveoli. A delicate network of veins is often visible just beneath the surface of the skin. )

The nurse is doing a 48-hour postpartum check on a client with mild gestational hypertension (GH). Which of the following data indicate that the GH is not resolving?

The client complains of a headache and blurred vision. (Option 3 is a symptom of the worsening of the GH.)

During a routine prenatal visit the client states, "I have not been able to get my wedding ring off for the past 2 days. I guess the heat is making my fingers swell." The nurse needs to further check:

The client for blood pressure changes and protein in the urine (Finger edema is a frequent forerunner of gestational hypertension and should be investigated further. Options 2, 3, and 4 are indicators of other problems such as molar pregnancy, diabetes, or infections.)

A client beginning week 30 of gestation comes to the clinic for a routine visit. Which of the following observations by the nurse indicates a need for teaching?

The client is wearing knee-high hose. (Varicose veins often develop in the lower extremities during pregnancy. Any constricting clothing, such as knee-high hose, impedes venous return from the lower legs and thus places the client at higher risk for developing varicosities. Clients should be encouraged to wear support hose (pantyhose). Flat, nonslip shoes with proper support are important to help the pregnant woman maintain proper posture and balance and minimize fall risks.)

A nurse is assisting in developing goals for the postpartum client who is at risk for infection. Which goal would be appropriate?

The client will be able to identify measures to prevent infection. (The uterus is theoretically sterile during pregnancy until the membrane ruptures, after which it is capable of being invaded by pathogens. Puerperal infection is a major cause of maternal morbidity and mortality. Option 3 is inaccurate. Options 1 and 2 are not directly related to infection.)

When caring for the pregnant client with human immunodeficiency virus (HIV), which goal would be appropriate?

The client will not develop an opportunistic infection during the remainder of pregnancy. (HIV is caused by a retrovirus that infects T lymphocytes. This disables the body's ability to fight infection. Nursing goals are directed at the prevention of infections. Sexual relations are not contraindicated with the proper use of protective devices. Options 3 and 4 are the focus of interventions, not goals.)

A nurse reviews the client's health record and notes that based on Leopold's maneuvers, the fetus is a cephalic presentation. The nurse understands that this is:

The common presentation (The cephalic presentation is more favorable than others and is the most common. Abnormal presentations result in prolonged labor and are likely to necessitate a cesarean birth.)

A nursing student prepares a teaching plan for a pregnant client newly diagnosed with diabetes mellitus. The nursing instructor suggests changing the plan if the student includes which information?

To avoid exercise because of the negative effects on insulin production (Options 1, 2, and 4 are important points to include in the teaching plan for the new diabetic client. Exercise is necessary for a pregnant diabetic woman. Concepts related to the timing of exercise, control of food intake, and insulin around the time of exercise should be included in the plan.)

A client in the prenatal clinic presents with a blood pressure reading of 134/90 mm Hg, which is an elevation from last month's reading of 104/66 mm Hg. Which additional sign or symptom suggests to the nurse that the client has mild preeclampsia?

Trace amount of protein (Preeclampsia is considered mild when the diastolic blood pressure does not exceed 100 mm Hg; proteinuria is no more than 500 mg/day (trace to 1+), and symptoms such as headache, visual disturbances, or abdominal pain are absent. Therefore the only sign of mild preeclampsia from the options given is a trace amount of protein. A rapid weight gain and generalized edema may occur. Headaches are present in severe preeclampsia.)

A nurse is measuring the fundal height of a client who is at 30 weeks of gestation. In preparing to perform the procedure the nurse should:

Turn the client onto her left side. (When measuring fundal height, the client lies in a supine position, and the nurse instructs the woman to turn onto her left side. The nurse then elevates the left buttock by placing a pillow under the area. This position will assist in preventing supine hypotension)

A nurse collects data from a pregnant client diagnosed with iron deficiency anemia during her third trimester for additional risk factors associated with the anemia. Which finding would support potential further maternal compromise?

Vaginal spotting twice since the last prenatal visit (A variety of factors can further complicate the potential maternal and fetal effects of iron deficiency anemias during pregnancy. Such factors include geographic location, socioeconomic status, daily nutrition and fluid intake, compliance with supplemental medication regimens, and blood loss during pregnancy. A history of vaginal spotting may compromise maternal hemoglobin levels even further during the antenatal period. Option 4 represents appropriate client behaviors during pregnancy to ensure adequate nutrition and fluid balance. Option 3 represents daily supplementation during pregnancy. Requiring an afternoon nap is not the usual during pregnancy.)

A nurse is collecting data from a pregnant client with a history of cardiac disease and is checking the client for venous congestion. The nurse inspects which body area, knowing that venous congestion is commonly noted in this area?

Vulva (Assessment of the cardiovascular system includes observation for venous congestion that can develop into varicosities. Venous congestion is most commonly noted in the legs, vulva, or rectum. It would be difficult to assess for edema in the abdominal area of a client who is pregnant. Although edema may be noted in the fingers and around the eyes, edema in these areas would not be directly associated with venous congestion.)

A nurse is collecting data from a pregnant client with a history of cardiac disease. The nurse is checking for venous congestion. The nurse inspects which of the following areas, knowing that venous congestion is most commonly noted here?

Vulva (Assessment of the cardiovascular system includes observation for venous congestion that can develop into varicosities. Venous congestion most commonly is noted in the legs, vulva, or rectum. It would be difficult to assess for edema in the abdominal area of a client who is pregnant. Although edema may be noted in the fingers and around the eyes, edema in these areas would not be associated directly with venous congestion.)

A client is a gravida IV, para III in her final trimester of pregnancy. She does not attend usual social functions because of the fear of stress incontinence. Her oldest child is in a school play, which she wants to attend. Which of the following is appropriate to suggest to the client?

Wear a perineal pad to the play. (Kegel exercises are useful to promote long-term bladder tone but will not be effective with one day's use. Limiting fluid intake can be harmful. A videotape will not satisfy the client's need to be present at the play. Wearing a perineal pad will give the client the security that she needs. The client should be instructed to remove a damp pad as soon as possible to decrease the incidence of infection.)

A nurse is reading the health care provider's (HCP) documentation regarding a pregnant client and notes that the HCP has documented that the client has an android pelvic shape. The nurse understands that this pelvic shape is:

Wedge-shaped and narrow and nonfavorable for a vaginal birth (The android pelvic shape is wedge-shaped and narrow and is a nonfavorable shape for a vaginal birth. A gynecoid pelvic shape is rounded with a wide pubic arch and is the most favorable pelvic shape for a vaginal birth. An anthropoid pelvic shape is long, narrow, and oval. It is not as favorable for a vaginal birth as the gynecoid pelvic shape; however, it is a more favorable pelvic shape than the platypelloid or android. The platypelloid pelvic shape is flattened with a wide, short oval shape and is a nonfavorable shape for a vaginal birth.)

A nurse is reading the health care provider's documentation regarding a pregnant client and notes that the health care provider has documented that the client has an android pelvic shape. The nurse understands that this pelvic shape is:

Wedge-shaped, narrow, and nonfavorable for a vaginal birth (The android pelvis is wedge-shaped and narrow and is nonfavorable for a vaginal birth. A gynecoid pelvic shape is rounded with a wide pubic arch and is the most favorable shape for a vaginal birth. An anthropoid pelvis is long, narrow, and oval. It is not as favorable of a shape for a vaginal birth as the gynecoid pelvis; however, it is a more favorable pelvic shape than the platypelloid or android. The platypelloid pelvis is flattened with a wide, short, oval shape and is also a nonfavorable shape for a vaginal birth.)

A nursing instructor instructs the nursing students that surfactant is a substance needed to facilitate neonatal breathing. The instructor asks a nursing student to identify when this substance begins to be produced. The nursing student responds correctly by stating that this substance is produced at approximately which gestational week?

Week 28 (Surfactant, a substance needed to facilitate neonatal breathing, begins to be produced at approximately week 28. Therefore the remaining options are incorrect.)

A nurse is gathering data from a pregnant client about physiological risk factors. The nurse would be sure to obtain which priority data?

Weight and height (Height and weight are important factors to assess when determining physiological risk factors. Although options 1, 2, and 3 are important to determine, they are not directly related to physiological risk factors.)

During the first trimester of pregnancy, a client complains of frequent nausea followed by vomiting. On data collection, which finding would indicate a serious nutritional disorder of pregnancy?

Weight compared to last visit is a loss of 2.3 pounds. (Weight loss along with the symptoms described in the question could indicate hyperemesis gravidarum. Ketone bodies, if present, would indicate protein wasting. Patellar reflexes would be used during magnesium sulfate administration. Chadwick's sign may be an indicator of pregnancy.)

A pregnant client in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home for progression of the disease process. The home care nurse teaches the client about the signs that need to be reported to the health care provider (HCP) and tells the client to call the HCP if:

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.)