Antepartum Prep U
A multigravid client visits the clinic because she suspects that she is pregnant but is unable to tell the nurse when her last menstrual period began. The client has a history of preterm birth. The nurse instructs the client that the gestational age of the fetus can be estimated by which of the following?
Ultrasonography. An ultrasound can provide a fairly accurate estimate of the fetal gestational age through various measurements of fetal landmarks. Amniocentesis is appropriate for determining genetic deviations and fetal lung maturity (lecithin-to-sphingomyelin ratio). Percutaneous umbilical blood sampling is used to detect genetically transmitted (inherited) blood disorders, acidosis, or infection. Alpha-fetoprotein levels are performed between the 15th and 20th weeks of gestation to determine if neural tube defects are present.
A client has her first prenatal visit at 15 weeks' gestation. Which finding requires further investigation?
Fundal height of 18 cm Fundal height (in centimeters) should equal the number of weeks' gestation. This client should have a fundal height of 15 to 16 cm. The blood pressure, urine, and weight findings are within normal limits for this client.
A client comes to the office for her first prenatal visit. She reports that January 3 was the first day of her last menstrual period. According to Nägele's rule, what date should the nurse record as the estimated date of delivery (EDD)?
October 10 The nurse can calculate EDD using Nägele's rule (add 7 days to the first day of the last menstrual period, then subtract 3 months, and finally add 1 year). In this example, January 3 + 7 days = January 10. Three months prior to that date is October 10 of the previous year. Adding 1 year, her EDD is October 10 of the current year.
After teaching a pregnant client about potential complications of amniocentesis that must be reported immediately, the nurse determines that the client understands the instruction when she says that she will report:
Vaginal bleeding. Possible complications associated with amniocentesis include hemorrhage from penetration of the placenta, infection of the amniotic fluid, possible puncture of the fetus, and uterine irritation leading to premature labor. Therefore, after amniocentesis, the client should promptly report any vaginal discharge or bleeding, a decrease in fetal movement, or uterine contractions. Typically nausea is not a complication of amniocentesis. Urinary frequency is not a complication of amniocentesis. Irregular painless uterine tightness (Braxton-Hicks contractions) is not a complication of amniocentesis
A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which of the following responses would be most helpful?
"What is it that concerns you about pregnancy, labor, and childbirth?" The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helpful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States and Canada, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States and Canada include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client's concerns and block further therapeutic communication. Also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety.
A 24-year-old nulligravid client with a history of irregular menstrual cycles visits the clinic because she suspects that she is "about 6 weeks pregnant." An ultrasound is scheduled in 2 weeks. The nurse should instruct the client that this test will be done to:
Assess gestational age. In the first trimester, ultrasound scanning typically is ordered to determine the gestational age. This is especially important for a client with a history of irregular menstrual cycles to establish an accurate due date. There is no reason at this point in pregnancy to determine whether twins are present. This might be indicated if the fundal height were larger than the gestational age may indicate. Identifying the gender of the fetus is not a reason for an ultrasound examination unless there is a history of sex-linked genetic disorders. Pelvic adequacy can be determined by physical examination. If the client has a borderline pelvis, an ultrasound scan cannot confirm this. Pelvimetry can be done, but it is not performed as frequently as it once was.
A 17-year-old client at 33 weeks' gestation diagnosed with mild preeclampsia is prescribed bed rest at home. The nurse instructs the client to contact the health care provider immediately if she experiences which of the following?
Blurred Vision Severe headache, visual disturbances such as blurred vision, and epigastric pain are associated with the development of severe preeclampsia and possibly eclampsia. These danger signs and symptoms must be reported immediately. Severe headache and visual disturbances are related to severe vasoconstriction and a severe increase in blood pressure. Epigastric pain is related to hepatic dysfunction. Ankle edema is common during the third trimester. However, facial edema is associated with increased fluid retention and the progression from mild to severe preeclampsia. Increased energy levels are not associated with a progression of the client's preeclampsia or the development of complications. In fact, some women report an "energy spurt" before the onset of labor. Mild backache is a common discomfort of pregnancy, unrelated to a progression of the client's preeclampsia. It also may be associated with bed rest when the mattress is not firm. Some multiparous women have reported a mild backache as a sign of impending labor.
The mother of a 17-year-old girl with Down syndrome tells the nurse that her daughter recently stated that she has a boyfriend. The mother is concerned that her daughter might become pregnant. Which of the following is the most appropriate suggestion by the nurse?
"I understand your concern; you may want to start your daughter on a birth control pill." Children with Down syndrome have intelligence that ranges from severe intellectual disability to low-average intellect. As a result, there are legitimate concerns over the adolescent's ability to make informed choices regarding sexual activity. Starting her on birth control pills will greatly reduce the risk of unwanted pregnancy. Most women with Down syndrome are fertile; however, children born to women with Down syndrome often have congenital defects. An abstinence program may not be effective because of the intellectual level of children with Down syndrome. Suggesting that the adolescent break off the relationship does not ensure that she will.
One week after her prenatal visit, a primigravid client at 38 weeks' gestation diagnosed with mild pre-eclampsia calls the clinic nurse reporting a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client:
"I think the doctor should see you today. Can you come to the clinic this morning?" A client with preeclampsia reporting a continuous headache for 2 days should be seen by a health care provider immediately. Continuous headache, drowsiness, and mental confusion indicate poor cerebral perfusion and are symptoms of severe preeclampsia. Immediate care is recommended because these symptoms may lead to eclampsia or seizures if left untreated. Advising the client to take two acetaminophen tablets would be inappropriate and may lead to further complications if the client is not evaluated and treated. Although the application of cool compresses may ease the pain temporarily, this would delay treatment. Aspirin with codeine may temporarily relieve the client's headache. However, this delays immediate treatment, which is crucial. Additionally, pregnant women are advised not to take aspirin at this time because it may cause clotting problems in the neonate. Codeine generally is not prescribed.
A 30-year-old primiparous client at 34 weeks' gestation comes to the prenatal facility concerned about the reddish streaks she has increasingly developed on her breasts and abdomen. She asks what these skin changes are and whether they're permanent. What should the nurse tell her?
These streaks are called striae gravidarum, or stretch marks; they'll grow lighter after birth. The client's weight gain and enlarging uterus, combined with the action of adrenocorticosteroids, lead to stretching of the underlying connective tissue of the skin, creating striae gravidarum in the second and third trimesters. Better known as stretch marks, these streaks develop most often in skin covering the breasts, abdomen, buttocks, and thighs. After delivery, they typically grow lighter. Linea nigra is a dark line that extends from the umbilicus or above to the mons pubis. In the primigravid client, this line develops at approximately the third month of pregnancy. In the multigravid client, linea nigra typically appears before the third month. Tiny bright hemangiomas may occur during pregnancy as a result of estrogen release. They're called vascular spiders because of the branching pattern that extends from each spot. Nevi are circumscribed, benign proliferations of pigment-producing cells in the skin.
A primigravid client visits the clinic at 12 weeks' gestation and tells the nurse that she has a cold and her nose is stuffy. The nurse should instruct the client to treat the nasal stuffiness by using:
Saline Nose Drops Saline nose drops are a natural remedy and can alleviate the discomfort. Clients who are pregnant should not take any medications without consulting the health care provider; therefore, oral antihistamines should be avoided. Clients who are pregnant should not take any medications without consulting the health care provider; therefore, oral decongestants should be avoided. Ice packs are not helpful in alleviating congestion. Warm moist towels might be helpful.
A nurse is reviewing a client's prenatal history. Which finding indicates a genetic risk factor?
The client has a child with cystic fibrosis. Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. Maternal age isn't a risk factor until age 35, when the incidence of chromosomal defects increases. Maternal exposure to rubella during the first trimester may cause congenital defects. Although a history of preterm labor may place the client at risk for preterm labor, it doesn't correlate with genetic defects.
The nurse is teaching a woman who is 18 weeks pregnant about normal findings. Which findings are expected at this time?
• Fundal height of approximately 18 cm • Quickening Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton-Hicks contractions, and leg cramps are common during the third trimester.
A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client?
"Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative." After a molar pregnancy, the client should receive follow-up care, including regular hCG testing, for 1 year because of the risk of developing chorionic carcinoma. After removal of a hydatidiform mole, the hCG level gradually falls to a negative reading unless chorionic carcinoma is developing, in which case the hCG level rises. A Pap test isn't an effective indicator of a hydatidiform mole. A follow-up examination would be scheduled within weeks of the client's discharge. The client must not become pregnant during follow-up care because pregnancy causes the hCG level to rise, making it indistinguishable from this early sign of chorionic carcinoma.
Which findings are considered positive signs of pregnancy?
Fetal heartbeat and fetal movement on palpation Fetal heartbeat and fetal movement on palpation are considered positive signs of pregnancy because they can't be caused by any other condition. Fatigue can be caused by chronic illness or anemia. Skin changes can result from cardiopulmonary disorders, estrogen-progesterone hormonal contraceptives, obesity, or a pelvic tumor. Excessive flatus or increased peristalsis can cause the perception of quickening. Breast changes can be related to hyperprolactinemia induced by sedatives, infection, prolactin-secreting pituitary tumor, pseudocyesis, or premenstrual syndrome. Abdominal enlargement can result from ascites, obesity, or uterine or pelvic tumor, and the perception of Braxton Hicks contractions can result from hematometra or a uterine tumor.
A client who is 7 weeks pregnant comes to the clinic for her first prenatal visit. She reports smoking 20 to 25 cigarettes per day. When planning the client's care, the nurse anticipates informing her that if she doesn't stop smoking, her fetus may be at risk for:
Low Birth Weight The risk of intrauterine growth restriction may increase with the number of cigarettes a pregnant woman smokes. Neural tube defects (such as spina bifida), cardiac abnormalities (such as tetralogy of Fallot), and renal disorders (such as hydronephrosis) are associated with multifactorial genetic inheritance, not maternal cigarette smoking.
As she tries to decide on a birth control method, a client requests information about medroxyprogesterone. Which statement represents the nurse's best response?
Medroxyprogesterone needs to be administered every 12 weeks. Medroxyprogesterone will provide effective birth control for 3 months, and it may be the birth-control method of choice for clients who are breast-feeding because studies haven't established any contraindications. There is no evidence that the drug has a high failure rate.
When teaching a multigravid client diagnosed with mild preeclampsia about nutritional needs, which of the following types of diet should the nurse discuss?
Regular Diet For clients with mild preeclampsia, a regular diet with ample protein and calories is recommended. If the client experiences constipation, she should increase the fiber in her diet, such as by eating raw fruits and vegetables, and increase fluid intake. A high-residue diet is not a nutritional need in preeclampsia. Sodium and fluid intake should not be restricted or increased. A high-protein diet is unnecessary.
When explaining the risk for having a child with cystic fibrosis to a husband and wife, the nurse should tell them?
The risk is greatest when both clients have the recessive gene. Cystic fibrosis is an autosomal recessive genetic disorder. This means that both parents have the gene. There is a one in four chance with each pregnancy from such parents that the child will have cystic fibrosis.
A pregnant client in her third trimester asks why she needs to urinate frequently again, as she did during the first trimester. What should the nurse tell her?
This symptom is normal and results from the fetus exerting pressure on the bladder. During the first trimester, hormonal changes and uterine pressure on the bladder cause urinary frequency and urgency. During the second trimester, when the uterus rises out of the pelvis, urinary symptoms abate. However, as term approaches, pressure on the bladder by the presenting part of the fetus again causes urinary frequency and urgency. Urinary frequency isn't abnormal unless accompanied by other urinary symptoms, such as burning and pain. Fluids shouldn't be limited during pregnancy. Urinary frequency doesn't subside after the presenting part is engaged. Instead, the presenting part exerts pressure on the bladder.
A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse anticipates that at 16 weeks' gestation, the client's fetus will:
have audible heart sounds. Fetal heart tones are usually audible using Doppler ultrasound around 12 weeks' gestation. The fetus can suck and swallow at about 20 weeks' gestation. The eyes are open at approximately 28 weeks' gestation. The nostrils are open at about 21 to 28 weeks' gestation
A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client:
tea and gelatin dessert. A clear liquid diet consists of foods that are clear liquids at room temperature or body temperature, such as ice pops, regular or decaffeinated coffee and tea, gelatin desserts, carbonated beverages, and clear juices. Milk, pasteurized eggs, egg substitutes, and oatmeal are part of a full liquid diet.
On entering the room of a client who has undergone a dilatation and curettage (D&C;) for a spontaneous abortion, the nurse finds the client crying. Which of the following comments by the nurse would be most appropriate?
"I'm truly sorry you lost your baby." The death of a fetus at any time during pregnancy is a tragedy for most parents. After a spontaneous abortion, the client and family members can be expected to suffer from grief for several months or longer. When offering support, a simple statement such as "I'm truly sorry you lost your baby" is most appropriate. Therapeutic communication techniques help the client and family understand the meaning of the loss, move less stressfully through the grief process, and share feelings. Asking the client whether she is experiencing a great deal of uterine pain is inappropriate because this is a "yes-no" question and doesn't allow the client to express her feelings. Saying that the embryo was defective is inappropriate because this may lead the client to think that she contributed to the fetus's demise. This is not the appropriate time to discuss embryonic or fetal malformations. However, the nurse should explain to the client that this situation was not her fault. Telling the client that she should get pregnant again as soon as possible is not therapeutic and discounts the feelings of the expectant mother who had already begun to bond with the fetus.
A primigravid client asks the nurse if she can continue to have a glass of wine with dinner during her pregnancy. Which of the following would be the nurse's best response?
"You should abstain from drinking alcoholic beverages." Maternal alcohol use may result in fetal alcohol syndrome, marked by mild to moderate mental retardation, physical growth restriction, central nervous system disorders, and feeding difficulties. Because there is no definitive answer as to how much alcohol can be safely consumed by a pregnant woman, it is recommended that pregnant clients be taught to abstain from drinking alcohol during pregnancy. Smoking and other medications also may affect the fetus.
A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug?
Ampicillin Oral contraceptives may interact with other medications and the effectiveness may be decreased if the client is prescribed ampicillin, tetracycline, or anticonvulsants, such as phenytoin. Indomethacin, an anti-inflammatory agent; amitriptyline, an antidepressant agent; and omeprazole, a drug used to suppress gastric acid secretion do not decrease the effectiveness of oral contraceptives.
A pregnant woman states that she frequently ingests laundry starch. The nurse should assess the client for:
Anemia All pregnant clients should be screened for pica, or the ingestion of nonfood substances, such as clay, dirt, or laundry starch. Commonly, clients who practice pica are anemic. Muscle spasms are not associated with the ingestion of laundry starch. However, they may be related to seizure disorder or seizure activity or a calcium deficiency. Lactose intolerance is not associated with the ingestion of laundry starch. Lactose intolerance would occur when the client ingests milk or milk products. Diabetes mellitus is not associated with the ingestion of laundry starch. Diabetes mellitus is associated with abnormal glucose levels, excessive thirst, and frequent voiding.
When caring for the pregnant client with hyperemesis gravidarum, the nurse would further assess the client for which of the following?
Dehydration Based on this client's history of hyperemesis gravidarum, the nurse needs to assess for signs and symptoms of possible dehydration such as scanty urine output, lassitude, and fever. Abdominal pain is not associated with hyperemesis gravidarum and should not be present. Abdominal pain may be suggestive of a gastric ulcer. The client should not experience any leaking amniotic fluid. A pinkish vaginal discharge or bright-red bleeding is not associated with hyperemesis gravidarum and should not be present.
A primigravid client at 36 weeks' gestation with premature rupture of the membranes is to be discharged home on bed rest with follow-up by the home health nurse. After instruction about care while at home, which of the following client statements indicates effective teaching?
I should contact the doctor if my temperature is 100.4° F (38°C) or higher. Because of the client's increased risk for infection, successful teaching is indicated when the client states that she will contact the doctor if her temperature is 38° C (100.4° F) or greater. The client should be instructed to monitor her temperature twice daily. The client should refrain from coitus, douching, and tub bathing, which can increase the potential for infection. Showering is permitted because water in the shower doesn't enter the vagina and increase the risk of infection. A fluid intake of at least 2 L daily is recommended to prevent potential urinary tract infection.
A pregnant client arrives in the emergency department and states, "My baby is coming." The nurse sees a portion of the umbilical cord protruding from the vagina. Why should the nurse apply manual pressure to the baby's head?
To relieve pressure on the umbilical cord Applying manual pressure to the baby's head by gently pushing up with the fingers relieves pressure on the umbilical cord. This intervention is effective if the cord begins to pulsate. The mother may also be placed in either the knee-chest or Trendelenburg's position to ensure blood flow to the baby. This intervention isn't done to slow the delivery process. A prolapsed cord necessitates emergency cesarean birth. The nurse shouldn't attempt to reinsert the umbilical cord because doing so would further compromise blood flow. At this point, the membranes are probably ruptured already.
The nurse and the health care provider are planning care for a multigravida hospitalized at 36 weeks' gestation with confirmed rupture of membranes (ROM) and no evidence of labor. Which of the following should the nurse initiate first?
Vaginal culture for Neisseria gonorrhea. The exact etiology of preterm premature rupture of membranes is unknown. Infection is considered an etiology and a problem associated with the ROM and can be life-threatening for both the mother and her fetus. Sources of infection that cause rupture of membranes are often vaginal infections or urinary tract infections, and this assessment should be initiated first. The sonogram will be helpful if there is a need to determine the amount of amniotic fluid present or the need to find a pocket of fluid to determine fetal lung maturity. Repeated cervical examinations set the patient up for infection; one exam would be needed to determine current status, but repetition is not indicated unless there is a need. Diversional activities will be an intervention that will be very helpful after stabilization of the client and if birth is not indicated at this time.
A client who's planning a pregnancy asks the nurse about ways to promote a healthy pregnancy. What is the nurse's best response?
"Folic acid, 400 mcg, improves pregnancy outcomes by preventing certain complications." When counseling a client who's planning to become pregnant, the nurse should discuss the role of folic acid in preventing neural tube defects. Telling the client not to worry ignores the client's needs. Practicing good health habits is an important topic to discuss with all clients, not just pregnant clients. Telling the client that a healthy pregnancy is up to nature is inaccurate.
During routine preconception counseling, a client asks how early a pregnancy can be diagnosed. What is the nurse's best response?
8 days after conception Based on human chorionic gonadotropin (hCG) levels in the blood and urine, pregnancy can be diagnosed as early as 8 days after conception, when the syncytiotrophoblast produces hCG. Sensitive and specific pregnancy tests can detect hCG in the blood and urine even before the first missed menstrual period. A missed period may also be related to other factors, such as poor nutrition, strenuous athletic activity, and certain drugs. Levels of hCG rise rapidly until about the 20th week of gestation. By the 20th week, they decline gradually and stay low for the remainder of gestation. Other hormones, such as human placental lactogen, estrogen, and progesterone, increase during pregnancy.
When teaching a primigravid client at 24 weeks' gestation about the diagnostic tests to determine fetal well-being, which of the following should the nurse include?
A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. The fetal biophysical profile includes fetal breathing movements, fetal body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. A reactive nonstress test is a sign of fetal well-being and does not require further evaluation. A nonreactive nonstress test requires further evaluation. A contraction stress test or oxytocin challenge test should be performed only on women who are at risk for fetal distress during labor. The contraction stress test is rarely performed before 28 weeks' gestation because of the possibility of initiating labor. Percutaneous umbilical cord sampling requires the insertion of a needle through the abdomen to obtain a fetal blood sample.
Which condition poses the greatest risk to a 32-year-old client who is 15 weeks pregnant and has a history of hypertension?
Abruptio placentae A history of hypertension predisposes the client for developing abruptio placentae. She isn't at risk for developing preterm labor, spontaneous abortion, or anemia
As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. The nurse should do which in order of priority from first to last?
Call for immediate assistance. Turn the client to her side. Maintain airway. Assess for ruptured membranes. If a client begins to have a seizure, the first action by the nurse is to remain with the client and call for immediate assistance. During the seizure, an airway is of great importance but using a tongue blade is not appropriate. Rolling the client to one side or another with assistance will assist in keeping the airway open. When the seizure is over, the nurse should assess the client for ruptured membranes and the fetal status.
A nurse in a prenatal clinic is assessing a client who's 24 weeks pregnant. Which findings lead this nurse to suspect that the client has mild preeclampsia?
Hypertension, edema, proteinuria The typical findings of mild preeclampsia are hypertension, edema, and proteinuria. Abdominal pain, blurry vision, and reduced urine output are signs of severe preeclampsia. Seizures are a sign of eclampsia. The other findings aren't typically found in women with preeclampsia.
A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that:
Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers. Folic acid supplementation is recommended to prevent neural tube defects and anemia in pregnancy. Deficiencies increase the risk of hemorrhage during delivery as well as infection. The recommended dose prior to pregnancy is 400 mcg/day; while breast-feeding and during pregnancy, the recommended dosage is 500 to 600 mcg/day. Blood glucose levels are not regulated by the intake of folic acid. Vitamin C potentiates the absorption of iron and is also associated with blood clotting or collagen formation.
A client makes a routine visit to the prenatal clinic. Although she's 14 weeks pregnant, the size of her uterus approximates an 18- to 20-week pregnancy. The physician diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:
Grapelike clusters In a client with gestational trophoblastic disease, an ultrasound performed after the third month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy occurs with an ectopic pregnancy.
A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews the physician prescriptions (see chart). Which of the following prescriptions should the nurse initiate first?
Initiate fetal and contraction monitoring. The nurse should initiate fetal and contraction monitoring for this client upon arrival to the unit. This gives the nurse data regarding changes in fetal and maternal contraction status before completing the other prescriptions. Next, the betamethasone would be given to begin the maturation process for the fetal lungs. Next, the nurse should start an intravenous infusion to provide a line for immediate intravenous access, if needed, and provide hydration for the client. The nurse should obtain the urine specimen prior to administering any antibiotic therapy, if prescribed.
A primigravid client with diabetes at 39 weeks' gestation is seen in the high-risk clinic. The primary health care provider estimates that the fetus weighs at least 4,500 g (10 lb). The client asks, "What causes the baby to be so large?" The nurse's response is based on the understanding that fetal macrosomia is usually related to which of the following?
Maternal Hyperglycemia Maternal hyperglycemia and poor control of the mother's diabetes mellitus have been implicated in fetal macrosomia. When the mother is hyperglycemic, large amounts of amino acids, free fatty acids, and glucose are transferred to the fetus. Although maternal insulin does not cross the placenta, the fetal pancreas responds by hypertrophy of the islet cells of the pancreas. The islet cells produce large amounts of insulin, which acts as a growth hormone. A family history of large infants usually is not the reason for large-for-gestational-age fetuses in diabetic mothers. Maternal hypertension is associated with small-for-gestational-age fetuses because of vasoconstriction of the maternal and placental blood vessels.
A nurse who works in a community-based clinic is implementing primary prevention with the clients who use the clinic. What should the nurse include in primary prevention activities?
Obtaining a rubella titer on a woman who is planning to start a family. Obtaining a rubella titer is a primary prevention activity. Rubella may cause birth defects when contracted during the first 3 months of pregnancy. Identifying those who do not have an immunity and then providing the vaccine is a primary prevention activity. The remaining selections fall under secondary and tertiary prevention.
When assessing a 34-year-old multigravid client at 34 weeks' gestation experiencing moderate vaginal bleeding, which of the following would most likely alert the nurse that placenta previa is present?
Painless vaginal bleeding. The most common assessment finding associated with placenta previa is painless vaginal bleeding. With placenta previa, the placenta is abnormally implanted, covering a portion or all of the cervical os. Uterine tetany, intermittent pain with spotting, and dull lower back pain are not associated with placenta previa. Uterine tetany is associated with oxytocin administration. Intermittent pain with spotting commonly is associated with a spontaneous abortion. Dull lower back pain is commonly associated with poor maternal posture or a urinary tract infection with renal involvement.
A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take first?
Place the client on her left side and start supplemental oxygen, as ordered, to maximize fetal oxygenation. The client's signs and symptoms indicate abruptio placentae, which decreases fetal oxygenation. To maximize fetal oxygenation, the nurse should place the client on her left side to increase placental blood flow to the fetus and administer supplemental oxygen, as ordered, to increase the blood oxygen level. Administering oxytocin isn't appropriate because this drug stimulates contractions, which further reduce fetal oxygenation. The nurse can't assure the client that everything will be all right, only that everything possible will be done to help her and her fetus. Fundal massage is used only during the postpartum period to control hemorrhage.
A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings reflect this woman is experiencing a cluster of which signs of pregnancy?
Probable. The plan of care should reflect that this woman is experiencing probable signs of pregnancy. She may be pregnant but the signs and symptoms may have another etiology. An enlarging abdomen and a positive pregnancy test may also be caused by tumors, hydatidiform mole, or other disease processes as well as pregnancy. Changes in the pigmentation of the face may also be caused by oral contraceptive use. Positive signs of pregnancy are considered diagnostic and include evident fetal heartbeat, fetal movement felt by a trained examiner, and visualization of the fetus with ultrasound confirmation. Presumptive signs are subjective and can have another etiology. These signs and symptoms include lack of menses, nausea, vomiting, fatigue, urinary frequency, and breast changes. The word "diagnostic" is not used to describe the condition of pregnancy.
After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which of the following hormones is produced by the placenta?
Testosterone The placenta does not produce testosterone. Human placental lactogen, hCG, estrogen, and progesterone are hormones produced by the placenta during pregnancy. The hormone hCG stimulates the synthesis of estrogen and progesterone early in the pregnancy until the placenta can assume this role. Estrogen results in uterine and breast enlargement. Progesterone aids in maintaining the endometrium, inhibiting uterine contractility, and developing the breasts for lactation. The placenta also produces some nutrients for the embryo and exchanges oxygen, nutrients, and waste products through the chorionic villi.
During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 20 beats/minute, each lasting 20 seconds. These increases occur only with fetal movement. What does this finding suggest?
The fetus is not in distress at this time. In an NST, reactive (favorable) results include two to three FHR increases of 15 beats/minute or more, each lasting 15 seconds or more and occurring with fetal movement. An oxytocin challenge test is performed to stimulate uterine contractions and evaluate the FHR. If results are inconclusive, a nipple stimulation contraction test may be ordered. A nonreactive result occurs when the FHR doesn't rise 15 beats/minute or more over the specified time; a nonreactive result may indicate fetal hypoxia.
A nurse is eating lunch at a restaurant when she sees a pregnant woman showing signs of airway obstruction. When the nurse asks the woman if she needs help, the woman nods her head yes. Indicate the area where the nurse's fist should be placed to effectively administer thrusts to clear the foreign body from the airway.
The fist is placed against the middle of the woman's sternum, with backward thrusts until the foreign body is expelled. The pressure from the backward thrusts causes compression of the ribs, further adding to the chest and lung pressure, thereby forcing the foreign body to move upward.
After instructing a multigravid client at 10 weeks' gestation diagnosed with chronic hypertension about the need for frequent prenatal visits, the nurse determines that the instructions have been successful when the client states which of the following?
"I need close monitoring because I may have a small-for-gestational-age infant." Women with chronic hypertension during pregnancy are at risk for complications such as preeclampsia (about 25%), abruptio placentae, and intrauterine growth restriction, resulting in a small-for-gestational-age infant. There is no association between chronic hypertension and hyperthyroidism. Pregnant women with chronic hypertension are not at an increased risk for hydramnios (polyhydramnios), an abnormally large amount of amniotic fluid. Clients with diabetes and multiple gestations are at risk for this condition. Placenta accreta, a rare placental abnormality, refers to a condition in which the placenta abnormally adheres to the uterine lining. It is not associated with chronic hypertension.
A client who is 37 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client's preparation for parenting, the nurse might ask which question?
What changes have you made at home to get ready for the baby? During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment. The type of anesthesia planned doesn't reflect the client's preparation for parenting. The client should have begun prenatal classes earlier in the pregnancy. The nurse should have obtained dietary information during the first trimester to give the client time to make any necessary changes.
A 17-year-old gravid client presents for a regularly scheduled 26-week prenatal visit. She appears disheveled, is wearing ill-fitting clothing, and does not make eye contact with the nurse. Which items should the nurse discuss with the client?
• Intimate partner violence. • Substance abuse. • Depression. • Glucose tolerance screening test. Anyone can be a victim of intimate partner violence, so healthcare workers should routinely assess women for it. Pregnant teens have increased risk for not finishing school, smoking, and substance abuse. It is possible that the client has depression and her appearance and lack of eye contact are symptoms. The nurse expects the glucose tolerance screening test to be ordered between 24 and 28 weeks' gestation to screen for gestational diabetes. HCG levels can identify a pregnancy or give information about an abnormal pregnancy. It would not be done at this time in a normal pregnancy
