Antepartum PrepU

A pregnant woman states that she frequently ingests laundry starch. The nurse should assess the client for which condition?

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.

A multigravid client at 38 weeks' gestation is scheduled to undergo a contraction stress test. What should the nurse include in the explanation as the purpose of this test?

assessment of fetal ability to tolerate labor The purpose of a contraction stress test is to determine fetal response during labor. If late decelerations are noted with the contractions, the test is considered positive or abnormal. Fetal lung maturity is evaluated through amniocentesis to obtain the lecithin-sphingomyelin ratio. The nonstress test is part of the biophysical profile. Determining fetal response during movements is evaluated as part of the nonstress test.

A client is having a level 2 ultrasound. A nurse knows that physicians order this procedure

for diagnostic purposes when fetal development is in question. Level 2 ultrasound is more sophisticated and can visualize fetal structures more clearly than a level 1 ultrasound. It's used for diagnostic purposes when fetal development is in question. Typically, level 1 ultrasound is used to assess gestational age. Diagnostic ultrasounds aren't ordered to satisfy the client's curiosity or to provide images of the fetus for family and friends

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time? "Drink coffee or tea to maintain hydration." "Apply cold compresses to relieve discomfort." "Maintain a supine position to promote rest." "Return to the facility if fever occurs."

"Return to the facility if fever occurs." The nurse should instruct a client in false labor to return to the health care facility if she develops signs or symptoms of infection, such as a fever; if her membranes rupture; if vaginal bleeding occurs; or if her contractions become more intense. The nurse should suggest warm milk or herbal tea, which promote relaxation and rest, instead of coffee or caffeinated tea. Taking a warm tub bath or shower — not applying cold compresses — helps relieve discomfort. A semi-upright position with pillows placed under the client's knees promotes rest.

The antenatal clinic nurse is educating a client with gestational diabetes soon after diagnosis. Evaluation for this client session will include which outcome? Select all that apply.

-The client states the need to maintain blood glucose levels between 70 to 110 mg/dL (3.9 to 6.2 mmol/L). -The client describes her planned walking program while pregnant. -The client will strive to maintain a hemoglobin A1C less than 6%. -The client will continue her prenatal vitamins, iron, and folic acid. The gestational diabetic needs to maintain blood glucose levels as close to "normal" as the nondiabetic pregnant woman. Walking is an excellent form of exercise for anyone and works well for pregnant diabetics as it burns calories, accelerates the heart rate, and as a result maintains the blood sugar at a lower level. During pregnancy continuously high blood glucose levels measured by a hemoglobin A1C of greater than 6 mg/dL (60 g/L) carry risks for the dyad. The suggested diet for a gestational diabetic is 1,800 to 2,400 cal/day to avoid the body breaking down maternal fat to maintain blood glucose levels. Continuing prenatal vitamins, iron, and folic acid (800 mcg/day) are general nutritional recommendations for pregnancy.

While assisting the physician with an amniocentesis on a multigravid client at 38 weeks' gestation, the nurse observes that the fluid is very cloudy and thick. The nurse interprets this finding as indicating which of the following? Intrauterine infection. Fetal meconium staining. Erythroblastosis fetalis. Normal amniotic fluid.

Intrauterine infection. Thick, cloudy amniotic fluid indicates an intrauterine infection. Typically, the client has a fever, lethargy, and malaise. Greenish-colored amniotic fluid is associated with meconium staining. A strong yellowish color is associated with erythroblastosis fetalis because of the presence of bilirubin and hemolyzed red blood cells. The normal color of amniotic fluid is clear or with a very slight yellow tint later in pregnancy.

The nurse teaches a pregnant client about the need to take supplemental vitamins with iron during her pregnancy. The nurse should instruct the client to take the iron with which liquid to promote maximum absorption?

orange juice Absorption of supplemental iron and nonmeat sources of iron is enhanced by combining them with meat or a good source of vitamin C. An acidic environment enhances iron absorption. Therefore, taking the iron on an empty stomach or with orange juice would be most effective. If gastrointestinal upset occurs, the client may take the drug with meals. However, doing so reduces iron absorption by 40% to 50%.Because milk interferes with the absorption of iron, the client should avoid taking the iron with milk.Tea has been shown to interfere with the absorption of iron. Therefore, the client should avoid taking the iron with tea.Hot chocolate, a milk product, interferes with iron absorption. Thus, the client should avoid taking the iron with hot chocolate.

When the nurse is assessing a 34-year-old multigravid client at 34 weeks' gestation experiencing moderate vaginal bleeding, which symptom 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.

The nurse is admitting a client with a suspected diagnosis of abruptio placentae. Which assessment data would require the nurse to notify the healthcare provider immediately? Select all that apply.

overt vaginal bleeding a rigid abdomen decreased blood pressure increased heart rate Abruptio placentae is the premature separation of a normally implanted placenta after the 20th week of gestation prior to birth. It is a medical emergency associated with potentially significant maternal blood loss. The onset is sudden. Bleeding can be concealed or visible, but visible blood is usually dark red. The abdomen is firm or rigid with the mother reporting constant pain, and the fetal heart rate is decreased. Vital signs can be within the normal range because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock, but it is important to assess for decreased blood pressure. When the blood pressure changes, the woman has lost a significant amount of blood. Tachycardia is a compensatory response to the blood loss. A creamy white vaginal discharge indicates a yeast infection. Symptoms of GI upset are not associated with an abruption.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of the fetus. The client's BPP score is 8. What does this score indicate? The fetus should be delivered within 24 hours. The client should repeat the test in 24 hours. The fetus isn't in distress at this time. The client should repeat the test in 1 week.

The fetus isn't in distress at this time. The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may be repeated if the score isn't within normal limits.

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.

A nurse is caring for a client after evacuation of a hydatidiform mole. The nurse should tell the client to:

use birth control for at least 1 year. After experiencing a hydatidiform mole, the client should be counseled to use a reliable method of birth control for at least 1 year. Because of the risk of choriocarcinoma, her hCG levels need to be monitored monthly for 1 to 2 years. If hCG levels remain low, a woman may try to become pregnant after 1 year. The risk of recurrence of a hydatidiform mole is low. Sterilization isn't necessary after a hydatidiform mole.

When planning a class for primigravid clients about the common physiologic changes of pregnancy, the nurse should include which information in the teaching plan?

Cardiac output increases by 25% to 50% during pregnancy. During pregnancy, the circulatory system undergoes tremendous changes. Cardiac output increases by 25% to 50%, and circulatory blood volume increases by about 30%. The client may experience transient hypotension and dizziness with sudden position changes. Early in pregnancy there is a slight increase in the temperature, and clients may attribute this to a sinus infection or a cold. The client may feel warm, but this sensation is transient. The level of circulating fibrinogen increases as much as 50% during pregnancy, probably because of increased estrogen. Any calf tenderness should be reported, because it may indicate a clot. Late in pregnancy, the posterior pituitary gland secretes oxytocin. The client may experience painful Braxton Hicks contractions or early labor symptoms.

A nurse is caring for a client who is scheduled for amniocentesis. What will the nurse teach the client about this procedure? She needs to empty her bladder prior to the procedure. Fetal monitoring will be done for 45 minutes prior to the procedure. An overnight stay in the hospital is needed. She may experience mild contractions after the procedure.

She needs to empty her bladder prior to the procedure. While preparing a client for an amniocentesis, the woman should empty her bladder to avoid the risk of bladder puncture. The fetus will be monitored for 20 minutes prior to the procedure to evaluate fetal well-being and obtain a baseline to compare after the procedure. If the mother is Rh-negative, RhoGam will be administered after the procedure to prevent potential sensitization to fetal blood. The fetal heart rate will be monitored continuously and the mother's vital signs every 15 minutes for an hour after the procedure. The nurse will assess the puncture site for bleeding. After recovery, the mother will go home to rest with instructions to report any bleeding or contractions. The mother should not have any contractions after the procedure.

A nurse is assessing a pregnant client who states that she smokes one pack of cigarettes each day. What should the nurse teach the client about smoking and pregnancy?

Smoking can cause a small size baby. The nicotine present in tobacco products has a vasoconstrictive effect, which reduces blood flow to the placenta and contributes to pre-term birth and low birth weight. Smoking also affects neuro and cognitive development. Nicotine crosses the placenta, so the fetus is being dosed with the drug each time the mother smokes. The best plan of action is to have the mother attend smoking cessation classes prior to pregnancy. If this cannot happen, then any restriction of smoking during pregnancy will help. Mothers who smoke can breastfeed their babies; the benefits of bonding and antibody protection are higher than the risk of nicotine exposure. Mothers are discouraged from smoking prior to breastfeeding, however, because smoking inhibits the letdown reflex. Vaping also exposes the fetus to nicotine, so it cannot be considered safe during pregnancy. Smoking does not affect blood glucose.

A client with a gravida 1 para 0 term pregnancy was discharged home last evening in false labor. The client returns to the hospital stating she has had strong contractions for the past 2 hours. Which assessments will indicate to the nurse that the client is in true labor?

cervical dilatation and effacement True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. True labor contractions bring about progressive cervical dilatation and effacement. These contractions start in the back and radiate toward the front of the abdomen. False labor contractions are irregular and do not get stronger with time. These contractions start in the front of the abdomen. The contractions decrease when walking. For a first baby, the client would have contractions every 2 minutes when she is in active labor, not early. Vaginal pressure and bulging membranes can occur at any time during labor, but neither define true or false labor.

A client diagnosed with gestational hypertension must have weekly blood pressure checks and urine testing at a clinic. She does not have transportation. How can the nurse help this client be compliant with her care?

Ask the clinic case manager to speak with the client. The nurse should ask the case manager to speak with the client because the case manager is familiar with community resources that can assist with transportation. Resources and additional support will greatly increase the client's compliance. The nurse can't set up cab service if the client doesn't have the funds to pay for transportation. The client may be noncompliant if she has no assistance or if she has to rely on a friend to help.

A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these findings as suggesting that the client's husband is experiencing which complication?

Couvade syndrome Couvade syndrome refers to the situation in which the expectant father experiences some of the discomforts of pregnancy along with the pregnant woman as a means of identifying with the pregnancy. Ptyalism is the term for excessive salivation. Mittelschmerz is the lower abdominal discomfort felt by some women during ovulation. Pica refers to an oral craving for substances such as clay or starch that some pregnant clients experience.

Which instruction should a nurse include in a home-safety teaching plan for a pregnant client?

Place a nonskid mat on the floor of the tub or shower. Using a mat for the floor of the shower or tub will prevent slipping. The client shouldn't clean the cat's litter box because doing so puts her at risk for toxoplasmosis. Wearing high heels may make the client lose balance and fall. The client doesn't need to completely avoid having area rugs around the house. Nonslip rugs can be used to prevent tripping or falling.

A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take?

Place the client on her left side and start supplemental oxygen, as ordered. 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 is not appropriate because this drug stimulates contractions, which further reduce fetal oxygenation. The nurse cannot 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.

An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which nursing intervention is most appropriate at this time?

Recommend a pregnancy test after acknowledging the client's distress. Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things she had thought about doing, giving the client some ideas about what to expect next, and questioning the client about her feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.

A client who is planning a pregnancy asks the nurse about ways to promote a healthy pregnancy. What is the nurse's best response?

"Start taking folic acid, 400 mcg daily until you conceive." When counseling a client who is planning to become pregnant, the nurse should discuss the role of folic acid in preventing neural tube defects. The recommended dose for folic acid is 400 mcg daily for at least 30 days prior to conception. After conception, it is recommended the dose increase to 800 mcg. For any woman who has had an infant with neural tube defects, the dosage is 4,000 mcg for the next pregnancy. Practicing good health habits is an important topic to discuss with all clients, not just pregnant clients. If the woman is participating in an exercise routine, it is safe to continue. Starting a new exercise program is not recommended, nor is it required to exercise every day. Telling the client to gain 10 lb during the first trimester is inaccurate, as is stating that more red meat is required to prevent anemia.

A client is in the eighth month of pregnancy. To enhance cardiac output and renal function, the nurse should advise the client to use which body position?

left lateral: The left lateral position shifts the enlarged uterus away from the vena cava and aorta, enhancing cardiac output, kidney perfusion, and kidney function. The right lateral and semi-Fowler positions don't alleviate pressure of the enlarged uterus on the vena cava. The supine position reduces sodium and water excretion because the enlarged uterus compresses the vena cava and aorta; this decreases cardiac output, leading to decreased renal blood flow, which in turn impairs kidney function.

After the nurse reinforces the danger signs to report with a gravida 2 client at 32 weeks' gestation with an elevated blood pressure, which client statements would demonstrate understanding of when to call the primary health care provider's (HCP's) office? Select all that apply.

"If I see any bleeding, even if I have no pain." "If I have a pounding headache that will not go away." "If the baby seems to be more active than usual." Vaginal bleeding with or without pain could signify placenta previa or abruptio placentae. Continuous or pounding headache could indicate an elevated blood pressure, and change in the strength or frequency of fetal movements could indicate that the fetus is in distress. Orthostatic hypotension can occur during pregnancy and can be alleviated by rising slowly. Leg veins may increase in size due to additional pressure from the increasing uterine size, while leg cramps may also occur and can commonly be decreased with calcium supplements.

A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can not believe I am going to have a baby!" Which response by the nurse would be most appropriate at this time?

"Yes it is true. How does that make you feel?"' This client is expressing a feeling of surprise about having a baby. Therefore, the nurse's best response would be to confirm the pregnancy, which is something that the client already suspects, and then ascertain how the client is feeling now that the suspicion is confirmed. Studies have shown that a common reaction to pregnancy is summarized as ambivalence or "someday, but not now." Such feelings are normal and are experienced by many women early in pregnancy. Offering a pamphlet on pregnancy does not respond to the client's feelings. Telling the client that she should be delighted ignores, rather than addresses, the client's feelings. Also, doing so imposes the nurse's opinion on the client. Ambivalence is a common reaction to pregnancy. Telling the client that she should be delighted may lead to feelings of guilt. Asking about the client's concerns is premature until the nurse determines the client's overall feelings about the pregnancy.

The nurse is facilitating a childbirth education class with a group of parents. On the first day of class, the nurse finds that none of the clients is a first-time parent. Which of the following would be a teaching strategy to best assist the clients?

Complete a needs assessment about what the parents are interested in learning. A needs assessment determines what parents already know and what they are interested in learning about. People will generally be more open to participate if it is a topic that they show an interest in. A needs assessment is used to determine learning needs and not strategies for change or ground rules for a respectful learning environment. A needs assessment can be used to evaluate whether topics of interest were covered at the end of a parenting session but this is not the major reason for doing a needs assessment at the beginning of a series of classes.

A nulligravid client with gestational diabetes tells the nurse that she had a reactive nonstress test 3 days ago and asks, "What does that mean?" The nurse explains that a reactive nonstress test indicates which of the following about the fetus?

Fetal well-being at this point in the pregnancy. A reactive nonstress test is a positive sign indicating that the fetus is doing well at this point in the pregnancy. For a nonstress test to be a reactive test, at least two accelerations (15 beats or more) of the fetal heart rate lasting at least 15 seconds must occur after movement. If the fetus were compromised, the nonstress test would demonstrate no accelerations in fetal heart rate; a contraction stress test would show fetal heart rate decelerations during simulated labor. Late decelerations are associated with a positive or abnormal contraction stress test. No accelerations in a 20-minute period during a nonstress test may mean that the fetus is sleeping; however, this is interpreted as a nonreactive nonstress test.

A multigravid client at 36 weeks' gestation who is visiting the clinic for a routine visit begins to sob and tells the nurse, "My boyfriend has been beating me up once in a while since I became pregnant, but I can't bring myself to leave him because I don't have a job and I don't know how I would take care of my other children." What is the priority action by the nurse at this time? You Selected:

Help the client make concrete plans for the safety of herself and her children. In this situation, the client has indicated that she is not willing to leave the abusive boyfriend because of potential economic concerns and other children in the household. The nurse should explain the cycle of abuse (e.g., tension-building phase, battering incident, and honeymoon phase). The priority intervention is to assist the client to make concrete plans for the safety of herself and her children. The client should identify the safest, quickest routes out of the house and be able to identify where she will go once the cycle of violence escalates. Contacting a social worker at this time is not appropriate because the client is not ready to leave the abusive situation. The nurse can tell the client that these services are available, but it is up to the client to determine whether a referral is necessary. Telling the client that she should not allow anyone to hit her or her children does not assist the client to make plans for her safety and the children's safety should the violence escalate. The client may have a flat affect or feel extreme humiliation from the abuse. The client may also be feeling that the abuse is her fault. When the client is ready to leave the abusive situation and receive continuous counseling, efforts can be made to increase her self-esteem and prevent additional violence. The client should be made aware of the available services in the community for women who are involved in abusive relationships. The location and phone numbers for available shelters should be provided to the client. Giving her a brochure related to the statistics about violence against women is not helpful and, if found by the abuser, may lead to further violence.

A client treated with terbutaline for premature labor is ready for discharge. Which instruction should the nurse include in the discharge teaching plan? -Report a heart rate greater than 120 beats/minute to the health care provider. -Take terbutaline every 4 hours, during waking hours only. -Call the health care provider if the fetus moves 10 times in an hour. -Increase activity daily if not fatigued.

Report a heart rate greater than 120 beats/minute to the health care provider. Because terbutaline can cause tachycardia, the client should be taught to monitor her radial pulse and call the health care provider for a heart rate greater than 120 beats/minute. Terbutaline must be taken every 4 to 6 hours around-the-clock to maintain an effective serum level that will suppress labor. A fetus normally moves 10 to 12 times per hour. The client does not need to contact the health care provider if such movement occurs. The client experiencing premature labor must maintain bed rest at home.

The health care provider prescribes clomiphene citrate for a woman who has been having difficulty getting pregnant. When teaching the client about this drug, the nurse should discuss what potential adverse effects?

chance of multiple gestation. Clomiphene citrate is a fertility drug that induces ovulation in women desiring pregnancy. One of the drug's most common adverse effects is multiple gestation (twins or triplets).An increase in spontaneous abortions is not associated with clomiphene citrate.Evidence does not support an association between the use of clomiphene citrate and an increase in fibrocystic breast disease.An increase in congenital anomalies is not associated with clomiphene citrate.

Assessment of a client progressing through labor reveals the following findings. Order the findings in the most likely sequence in which they would have occurred. Use all options.

strong Braxton Hicks contractions mild contractions lasting 20 to 40 seconds cervical dilation of 7 cm 100% cervical effacement uncontrollable urge to push Strong Braxton Hicks contractions typically occur before the onset of true labor and are considered a preliminary sign of labor. During the latent phase of the first stage of labor, contractions are mild, lasting approximately 20 to 40 seconds. As the client progresses through labor, contractions increase in intensity and duration. In addition, cervical dilation occurs. Cervical dilation of 7 cm indicates that the client has entered the active phase of the first stage of labor. Together with cervical dilation, cervical effacement occurs. Effacement of 100% characterizes the transition phase of the first stage of labor. Progression into the second stage of labor is noted by the client's uncontrollable urge to push.

A primigravid client at 32 weeks' gestation with ruptured membranes is prescribed to receive betamethasone 12 mg intramuscularly for two doses 24 hours apart. When teaching the client about the medication, what should the nurse include as the purpose of this drug?

to accelerate fetal lung maturity Corticosteroids, such as betamethasone, are prescribed for clients who are preterm to accelerate fetal lung maturity and reduce the incidence and severity of respiratory distress syndrome.Infection would be treated with antibiotics. Tocolytic therapy is used to reduce contractions.The nurse should monitor the fetal heart rate pattern, but betamethasone will not improve the fetal heart rate.

A primigravid client at 28 weeks' gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hours away. Which of the following recommendations by the nurse would be best?

"Taking the trip is okay if you stop every 1 to 2 hours and walk." The client traveling by automobile should be advised to take intermittent breaks of 10 to 15 minutes, including walking, every 1 to 2 hours to stimulate the circulation, which becomes sluggish during long periods of sitting. Automobile travel is not contraindicated during pregnancy unless the client develops complications. There is no set maximum number of hours allowed. The pregnant client should always wear a seat belt when traveling by automobile. The client should be aware of the nearest health care facility in the city to which she is traveling.

A pregnant client comes to the facility for her first prenatal visit. When providing teaching, the nurse should be sure to cover which topic? labor techniques danger signs during pregnancy signs and symptoms of pregnancy tests to evaluate for high-risk pregnancy

danger signs during pregnancy No matter how far the client's pregnancy has progressed by the time of the first prenatal visit, the nurse should teach about danger signs during pregnancy so the client can identify and report them early, helping to avoid complications. The nurse should discuss other topics just before they're expected to occur. For example, the nurse should teach about labor techniques near the end of pregnancy; signs and symptoms of pregnancy shortly before they're anticipated, based on the number of weeks' gestation; and any tests a few weeks before they're scheduled.

A client who is 24 weeks pregnant has sickle cell anemia. When preparing the care plan, the nurse should identify which factor as a potential trigger for a sickle cell crisis during pregnancy? sedative use dehydration hypertension tachycardia

dehydration Factors that may precipitate a sickle cell crisis during pregnancy include dehydration, infection, stress, trauma, fever, fatigue, and strenuous activity. Sedative use, hypertension, and tachycardia aren't known to precipitate a sickle cell crisis.

A client asks about complementary therapies for relief of discomfort related to pregnancy. Which comfort measure mentioned by the client indicates a need for further teaching?

herbal remedies A pregnant woman should avoid all medication unless instructed by the physician. This includes herbal remedies, because their effects on the fetus have not been identified. Meditation, music therapy, and acupuncture have all proven to enhance relaxation without harm to the mother or baby.

A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. How does the nurse interpret this finding?

normal because multiparous clients can experience quickening between 14 and 20 weeks' Although most multiparous women experience quickening at about 17½ weeks' gestation, some women may perceive it between 14 and 20 weeks' gestation because they have been pregnant before and know what to expect. Detecting movement early does not suggest a twin pregnancy. If the multiparous client does not experience quickening by 20 weeks' gestation, further investigation is warranted, because the fetus may have died, the client has a hydatidiform mole, or the pregnancy dating is incorrect. There is no evidence that the client's expected date of birth is erroneous.

A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor?

promoting adequate hydration Providing adequate hydration to the woman in premature labor may help halt contractions. The client should be placed on bed rest so that the fetus exerts less pressure on the cervix. A nutritious diet is important in pregnancy, but it won't halt premature labor. Nipple stimulation activates the release of oxytocin, which promotes uterine contractions.

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 hormone 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.

A client undergoes an amniotomy. Shortly afterward, the nurse detects large variable decelerations in the fetal heart rate (FHR) on the external electronic fetal monitor (EFM). These findings signify:

umbilical cord prolapse. After an amniotomy, a significant change in the FHR may indicate umbilical cord prolapse; an EFM may show large variable decelerations during cord compressions. Infection, the start of the second stage of labor, and the need for labor induction aren't associated with FHR changes. An infection causes temperature elevation. The second stage of labor starts with complete cervical dilation. Labor induction is indicated if the client's labor fails to progress.

A client progressing through pregnancy develops constipation. What is the primary cause of this problem during pregnancy?

reduced intestinal motility During pregnancy, hormonal changes and mechanical pressure reduce motility in the small intestine, enhancing water absorption and promoting constipation. Although decreased appetite, inadequate fluid intake, and prolonged gastric emptying may contribute to constipation, they aren't the primary cause.

After instructing a female client about the radioimmunoassay pregnancy test, the nurse determines that the client understands the instructions when the client states that which hormone is evaluated by this test?

human chorionic gonadotropin (hCG) The hormone analyzed in most pregnancy tests is hCG. In the pregnant woman, trace amounts of hCG appear in the serum as early as 24 to 48 hours after implantation owing to the trophoblast production of this hormone. Prolactin, follicle-stimulating hormone, and luteinizing hormone are not used to detect pregnancy. Prolactin is the hormone secreted by the pituitary gland to prepare the breasts for lactation. Follicle-stimulating hormone is involved in follicle maturation during the menstrual cycle. Luteinizing hormone is responsible for stimulating ovulation.

Which medication is considered safe during pregnancy?

insulin Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.

A client is admitted for an amniocentesis. Initial assessment findings include 16 weeks' gestation, vital signs within normal limits, hemoglobin 12.2 g/dL (122 g/L), hematocrit 35% (0.35), and type O-negative blood. Which action would the nurse complete first after amniocentesis has been completed?

Assess fetal heart rate and compare to pre-procedure baseline. After an amniocentesis, the client is placed in a position of comfort and the fetal heart rate is monitored and compared to the baseline tracings obtained pre-procedure to determine any signs of fetal distress. This is the first priority once the procedure is complete. Other immediate actions include monitoring maternal vital signs, which are reassessed every 15 minutes for 1 hour. The puncture site is assessed for bleeding or drainage, and the uterus is assessed for any contractions but these will be done once the fetal monitoring is established. Note that signs of infection at the site would not be apparent immediately after the procedure. RHo(D) immune globulin is administered after an amniocentesis if the client is Rh negative to prevent potential sensitization to fetal blood but this is not as urgent to complete as identification of fetal distress. The client is sent home and instructed to notify the healthcare provider of any contractions, vaginal bleeding, fever, or other signs of intra-amniotic infection (chorioamnionitis), or any changes in fetal activity (increased or decreased). This teaching can happen after all the other actions have been completed.

After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which statement?

"Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average." The National Academy of Sciences Institute of Medicine and Health Canada recommend that women gain 25 to 35 lb (11.5 to 14.5 kg) during pregnancy. The pattern of weight gain is as important as the total amount of weight gained. Underweight women and women carrying twins should have a greater weight gain. Typically, women should gain 3.5 lb (1.6 kg) during the first trimester and then 1 lb (0.45 kg)/week during the remainder of the pregnancy (24 weeks) for a total of about 27 to 28 lb (12.2 to 12.7 kg). A weight gain of only 6.6 lb (3 kg) in the second and third trimesters is not normal because the client should be gaining about 1 lb (0.45 kg)/week, or 12 lb (5.4 kg) during the second and third trimesters. Gaining 12 lb (5.4 kg) during each trimester would total 36 lb (16.2 kg), which is slightly more than the recommended weight gain. In addition, nausea and vomiting during the first trimester can contribute to a lack of appetite and smaller weight gain during this trimester.

A pregnant client and her partner come to preregister at the hospital and take a tour of the labor and delivery suite. The mother has a detailed birth plan she wants honored while in labor. How should the nurse best respond to this information?

"The nurses taking care of you will do their best to respect your wishes." A birth plan is developed by the parents to communicate their wishes and goals before, during, and after labor. It can include such things as the type of anesthesia, birthing positions, and props, and it can also specify issues such as delayed cord clamping or acceptance of an episiotomy. Labor and delivery personnel will attempt to honor the parents' wishes to the best of their ability. Plans do change, however, because no one can predict that all will be perfect during labor and delivery. Telling the parents that the nurses are excellent and they do not need a birth plan interferes with communication between the parents and staff and is not always true. A doula is not required to be with the parents if they have a birth plan. A well-developed birth plan should include wishes for labor augmentation, anesthesia, and emergency c-section, but situations arise that may preclude the wishes of the parents. This should be communicated to the parents. The healthcare personnel should convey to the parents that the primary goal is the safety of the mother and baby. Remediation: