ch 12 manage during preg

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy?

"Babies of women who smoke tend to weigh significantly less than other infants." Explanation: Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, intellectual disability, or nicotine dependence.

An older female pregnant with her first child develops some pain in her legs associated with warmth to touch. Suspecting a blood clot, an ultrasound is prescribed and a peripheral venous thrombosis is diagnosed. Which intervention was likely prescribed for this woman?

"Buy and wear medical support hose every day." Explanation: The woman should wear elastic support stockings and put them on before she arises in the morning because once she is on her feet, blood pooling begins, and the stockings will be less effective. The nurse should be certain a woman understands that the stockings she buys should be labeled "medical support hose." Otherwise, as many pantyhose manufacturers advertise their stockings as giving "firm support," she may assume erroneously this is sufficient for her. Blood thinners and aspirin are contraindicated in pregnancy. Because it stimulates venous return, exercise is as effective as rest periods for alleviating varicosities. Sitting at a desk for prolonged periods of time with legs bent at the knee also encourages venous stasis.

A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best?

"Your statistical risk of another tubal pregnancy is increased." Explanation: If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.

The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age?

20 weeks Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:

4 weeks. The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?

Always wear a three-point seat belt. To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. The nurse should instruct the client to deactivate the air bag if possible. The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. The nurse should instruct the client to use a lap belt that crosses over the pelvis below—not over—the uterus.

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?

Correct response: Rest on the left side for at least 1 hour in the morning and afternoon. Explanation: During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.

A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this?

Delay breakfast until mid-morning. The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply.

Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating. Eat a large amount of carbohydrates. Do not drink liquids with meals. The client is experiencing pyrosis. Eating small frequent meals, avoiding fried foods, and not laying down immediately after eating will minimize the discomfort. Large quantities of carbohydrates and not taking liquids with meals will not change the discomfort being experienced.

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?

Fats are essential during pregnancy, and vegetable oils are a good source. Explanation: Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?

G3 T0 P1 A1 L2 G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.

The nurse is documenting a non-pregnant client's obstetric history. The client informed the nurse she has 4 children living at home. She birthed one child at 34 weeks' gestation, one child at 37 weeks' gestation, one at 38 weeks' gestation, and one at 39 weeks' gestation. The client has had one abortion. Using the GTPAL format, how will the nurse document the client's obstetric history?

G5, T2, P2, A1, L4 Explanation: "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or elective (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).

The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the woman's diet?

Green leafy vegetables Green leafy vegetables are a good source of folic acid. In the past, green tea was thought to interfere with the absorption of folic acid; however, studies do not support this. The women would be advised to avoid green and iced tea due to the caffeine content. Yogurt, low-fat milk and oily fish are not known to be high in folic acid.

Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client?

Instruct the client to refrain from emptying her bladder. Explanation: When assessing fetal well-being through abdominal ultrasonography, the nurse should instruct the client to refrain from emptying her bladder. The nurse must ensure that abdominal ultrasonography is conducted on a full bladder and should inform the client that she is likely to feel cold, not hot, initially in the test. The nurse should obtain the client's vital records and instruct the client to report the occurrence of fever when the client has to undergo amniocentesis, not ultrasonography.

Why is a Papanicolaou test done at the first prenatal visit?

It identifies abnormal cervical cells. A Pap test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?

Take antacid 1 hour after the multivitamin. Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.

The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client?

Walk for 30 minutes 5 days a week. For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?

amniotic fluid volume A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.

Which possible complication associated with back pain can lead to premature contractions?

bladder or kidney infection Explanation: Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. Increased ICP, spinal fluid leak, and a herniated disc are usually not associated with back pain during a normal pregnancy.

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting?

limiting intake of heavy, greasy foods Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.

A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client?

on her side with the weight of the uterus on the bed Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava.

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?

the use of OTC drugs with teratogens Explanation: Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?

vaginal bleeding In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.

A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?

According to Naegele rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?

at the level of the umbilicus By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum.

The nurse is completing the initial assessment at the prenatal visit of a pregnant client. Which question should the nurse prioritize when completing the review of systems?

"Have you had any urinary tract infections?" It is important to ensure the woman does not have any current infections as they can all contribute to adverse effects in the pregnancy. Any conditions the woman has had in the past may recur or be exacerbated during pregnancy. It is also possible for the woman to currently have a low-grade infection and not be aware of it. A urine culture may be required to ensure the woman does not currently have an infection. UTIs can contribute to premature labor.

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy?

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." Explanation: A prepregnant BMI of 23 is in the normal category, and this client needs to gain 25 to 35 lbs (11 to 16 kg) during this pregnancy. Lower weight gain would be recommended for women with a BMI of over 25.

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?

"I should substitute intercourse with nonsexual touch to avoid harming the fetus." Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching?

"I wear knee-highs rather than pantyhose." Explanation: Women with varicosities should not wear knee-high stockings as they put pressure on leg veins and reduce venous return.

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?

"I'll switch to chewing gum instead of using mints." Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.

The nurse is scheduled to see four clients. Which client is at highest risk for depression?

A 17-year-old at 32 weeks' gestation, living with a 22-year-old man who is not the father of her baby, because her parents made her move out when she got pregnant Explanation: Risk factors for depression are young age, lack of social support, and unintended pregnancy. A young client with the support of her partner and her parents is at less risk. Similarly, women in their 20's with resources such as a job and health insurance, a planned pregnancy as well as support of their partner and family are also at lower risk for depression.

A client who is 28 weeks' pregnant asks the nurse if it is safe to use mineral oil to relieve constipation. What is the best response by the nurse?

"No, mineral oil may interfere with the absorption of fat-soluble vitamins from your diet." Explanation: Mineral oil should be avoided because it interferes with the absorption of fat soluble vitamins that are needed by the fetus. It does not alter the absorption of water soluble vitamins, change the bulk of the stool, or cause preterm labor.

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?

"The gloves they provide irritate my hands, so I don't use them." Explanation: There are various chemicals which are recognized for their teratogenic effects and must be avoided during pregnancy. The nurse should find out which chemicals the client is exposed to and determine the risk factor. The greatest danger is the client handling chemicals without a barrier protection such as gloves. The other issues may also be dangers depending on the chemicals and the environment in which the client is working and should also be evaluated.

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?

12.0 cm Explanation: The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

At which gestational age will the nurse no longer associate fundal height directly with week's gestation?

36 weeks Explanation: The nurse is correct to no longer anticipate that the client's fundal height will equal the gestation age of the fetus following 36 weeks' gestation. This is due to variances in fetal growth. Up until that point, fundal height is a good predictor of where growth should be.

At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1C above which level is concerning for diabetes and warrants further testing?

6.5% A hemoglobin A1C level of at least 6.5% is concerning for overt diabetes, and further testing should be conducted to ensure the client does not have diabetes. If glucose testing is not diagnostic of overt diabetes, the woman should be tested for gestational diabetes from 24 to 28 weeks' gestation with a 75-gm oral glucose tolerance test.

A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of prenatal care? Select all that apply.

>....... Establish a baseline of present health. >....... Determine the gestational age of the fetus. >....... Monitor for fetal development and maternal well-being. X....... Maximize the risk of possible complications. >....... Identify women at risk for complications. X....... Increase the business of the clinic. The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

At the initial prenatal visit, the nurse learns a 24-year-old primigravida client is 8 weeks' pregnant. Past medical history is nonsignificant except for a history of obesity since age 13. The nurse should assess for which possible complications during pregnancy? Select all that apply.

>....... gestational diabetes >....... preeclampsia >....... gestational hypertension >....... fetal macrosomia X....... hyperemesis Based on the history of obesity and this being a first pregnancy, this client is at risk for developing gestational diabetes, preeclampsia, gestational hypertension, and fetal macrosomia. The risk for hyperemesis is no greater for this client than other pregnant clients.

A woman in her first trimester of pregnancy has noted an increase in a thick, whitish vaginal discharge even though she showers daily. The woman shares this information with the clinic nurse, who provides some client education on the topic of leukorrhea. Which interventions should be addressed in this discussion? Select all that apply.

>........... Wear cotton underwear during the day. >........... A perineal pad to absorb the discharge may help. X.......... Tampons are the most reliable product to control the flow during the day. X.......... It is normal for the discharge to change in color or odor. X.......... Many woman find douching to provide a feeling of cleanliness. Leukorrhea, a whitish, viscous vaginal discharge or an increase in the amount of normal vaginal secretions, occurs in response to the high estrogen level and the increased blood supply to the vaginal epithelium and cervix in pregnancy. Wearing cotton underpants and sleeping at night without underwear can be helpful. Some women may need to wear a perineal pad to absorb the discharge. Caution women not to use tampons because this could lead to stasis of secretions and subsequent infection. Advise women to contact their obstetric provider if there is a change in the color, odor, or character of this discharge as these suggest infection. Caution women not to douche; douching is contraindicated generally, and especially throughout pregnancy.

The nurse is reviewing rubella antibody testing results (above) for a pregnant client at 8 weeks' gestation. What action does the nurse anticipate based on these results?

Administer the measles-mumps-rubella (MMR) vaccine postpartum. Explanation: A rubella IgG antibody index of 0.7 to 1.0 (7 to 10 international units/ml) is equivocal and an additional dose of measles-mumps-rubella (MMR) vaccine is indicated in order to develop sufficient immunity to rubella. The MMR vaccine is a live vaccine and cannot be given in pregnancy. It should be administered postpartum. Breastfeeding is not a contraindication to live vaccine administration; the MMR vaccination does not need to be deferred until after weaning.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?

An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?

Ask her to describe her intake for the last 24 hours. A 24-hour food intake history is the best method to assess food intake in all individuals.

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications. The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications. Explanation: The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).

A nurse is teaching a group of primigravida women who are in their first trimester. One of the women asks the nurse about sexual activity during pregnancy. Which information would the nurse most likely incorporate into the response?

Because of pelvic congestion, women may experience increased clitoral sensitivity. Explanation: Only a few complications of pregnancy such as vaginal bleeding and ruptured membranes limit sexual activity. A partially dilated cervix does not warrant a restriction in sexual activity.

A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise?

Come to the hospital now for assessment. Generally, clients are advised to come to the hospital once contractions are 5 minutes apart, but because this client has a history of fast (4 hour) labor and lives 45 minutes away from the hospital, the client should be advised to come to the hospital now. Membranes may rupture at any point in labor and should not dictate the timing of hospital admission. Bloody show is a normal finding in labor, but it does not determine the stage of labor or when the client should come to the hospital.

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.

During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit?

Correct response: The client reduces her smoking by 50 percent by the next clinic visit. Explanation: When establishing goals and outcomes, the nurse should be certain that plans are individualized and realistic for a woman's situation and lifestyle and should try to turn long-term goals into more manageable, short-term ones. For example, a goal of reducing smoking during pregnancy may be more realistic than a goal of stopping smoking forever. This eliminates the pressure of making a major permanent lifestyle change. Sudden cessation of smoking is not beneficial because the woman will have to cope with withdrawal symptoms. The client will likely be noncompliant with this request. Having the client research smoking during pregnancy is also unrealistic during this initial visit. The client has to be motivated before the goal can be set.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?

Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:

G = 3, T = 1, P = 0, A = 1, L = 1 The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?

Gravida (G) indicates the number of pregnancies. When a nurse calculates the GP of a pregnant client, the current pregnancy counts as one, the twin pregnancy counts as one, and the previous pregnancies count as two for a gravida of 4. Para (P) indicates the number of pregnancies that result in birth at a viable gestational age. The birth of multiples count as one. Thus, this client has a 2-year-old and one set of twins, for a para of 2.

Which medical pair is the highest concern if reported during a pregnant client's medical history?

Heart disease and diabetes The highest concern is heart disease and diabetes. Due to the increase in circulating blood volume, the heart has significantly more workload. Diabetes must be closely regulated, as a high glucose can have an impact on the status of the fetus. All of the other options are important to discuss with the health care provider but not of highest concern.

The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility?

Hemolytic anemia Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.

The nurse is assessing a client at 14 weeks' gestation at a routine prenatal visit and notes the fundal height is at the umbilicus. The nurse will most likely interpret this finding to indicate which situation?

Multiple fetal pregnancy Explanation: The fundus typically is at the level of the umbilicus at 20 weeks' gestation. Therefore the fundal height is greater than that which is expected, suggesting possible multiple gestation, polyhydramnios, fetal anomalies, or macrosomia. Smaller than expected measurements would suggest intrauterine growth retardation or possibly inadequate amount of amniotic fluid. Urinary retention would displace the uterus.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs

Refrain from crossing legs when sitting for long periods. Explanation: To help the client alleviate varicosities of the legs, the nurse should instruct the client to refrain from crossing her legs when sitting for long periods. The nurse should instruct the client to avoid standing, not sitting, in one position for long periods of time. The nurse should instruct the client to wear support stockings to promote better circulation, though the client should stay away from constrictive stockings and socks. Applying heating pads on the extremities is not reported to alleviate varicosities of the legs.

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?

Take antacid 1 hour after the multivitamin. Explanation: Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.

A client at 29 weeks' gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next?

Tell the client these are normal findings during pregnancy. The hormone relaxin causes the smooth muscles, joints, and ligaments of the body to relax. Because of the production of relaxin during pregnancy, women often experience aches in the pelvic area. The nurse would explain to the client this is a normal finding of pregnancy and will resolve. The nurse should document this in the chart, but it is not priority over educating the client.

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.

The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse?

The steroids speed up the development of the lungs. Steroids given to the mother before birth help to speed up the development of the fetal lungs. The use of prenatal steroids has decreased the mortality rate in preterm infants. Prenatal steroids do not increase muscle mass or amount of fat tissue to aid in temperature regulation. Prenatal steroids do not have an impact on the development of sepsis in either the mother or neonate.

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time?

at 28 weeks Explanation: If indicated, Rho(D) immune globulin should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+.

Encouraging routine prenatal visits is an important function for nurses to ensure the clients avoid complications or difficulties throughout the pregnancy and birth. The nurse would prepare to screen clients for gestational diabetes at which time during the pregnancy?

between 24 and 28 weeks' gestation Explanation: Screening for gestational diabetes is best done between 24 and 28 weeks' gestation, unless screening is warranted in the first trimester for high-risk reasons. If the initial screening is elevated, then further testing should be conducted to confirm the diagnosis.

A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information?

biophysical profile Explanation: A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detected via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.

While assessing a client's breast during the third trimester, which finding would the nurse expect?

colostrum from the nipples Explanation: During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.

A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?

dark, leafy green vegetables Dark leafy green vegetables are a source of calcium. Red and orange vegetables contain a variety of vitamins, bread and rice contain carbohydrates, and meat and fish contain protein, but none of these foods are a good source of calcium.

During a routine prenatal visit, the woman complains about lack of sleep due to "the baby having a dance party at night which keeps me awake with all the kicking." Which nursing diagnosis would be most appropriate for the nurse to document?

disturbed sleep pattern related to frequent movement of fetus at night Explanation: The nursing diagnosis that might be most appropriate for a woman experiencing the minor body symptom (lack of sleep) of early pregnancy would be disturbed sleep pattern related to frequent movement of fetus during night. Fatigue is normal in pregnancy because of the increased physiological needs for sleep and rest. Fetal movements are usually not associated with intense pain. Sleep medication is contraindicated during pregnancy if at all possible.

Some pregnant women hire a trained professional to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who takes this role?

doula The pregnant woman may hire a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?

episodes of double vision Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.

Which finding is most worrisome in a client in her 26th week of pregnancy?

facial edema Explanation: Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur?

fetal tachycardia

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?

maternal serum alpha-fetoprotein analysis Explanation: Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The Doppler flow study evaluates the blood flow, and amniocentesis evaluates the contents of the amniotic fluid looking for chromosomal defects.

A nurse is caring for a 20-year-old primigravida client who is at 18 weeks' gestation. The client had been experiencing occasional nausea and vomiting in the morning and now reports persistent nausea and vomiting in the past 48 hours. Client has lost 3 lb (1.36 kg) in 2 days. The nurse performs a comprehensive assessment on the client. Vital signs: heart rate, 110 beats/minblood pressure, 88/56 mm Hg. Laboratory values: blood urea nitrogen (BUN), 25 mg/dl (8.93 mmol/l) and sodium 148 mEq/l (148 mmol/l)

persistent nausea and vomiting in the past 48 hours. Client has lost 3 lb (1.36 kg) in 2 days heart rate, 110 blood pressure, 88/56 mm Hg Hyperemesis gravidarum usually occurs during the first trimester of pregnancy due to high human chorionic gonadotropin (hCG) levels. Hyperemesis gravidarum is persistent nausea and vomiting with weight loss due to inability to ingest food or fluid, which leads to dehydration. A 3-lb (1.36-kg) weight loss in 2 days due to persistent nausea and vomiting is an indication the client is experiencing hyperemesis gravidarum. The weight loss is due to the client's inability to ingest food or fluids, which leads to severe dehydration and malnutrition. The nurse should request intravenous fluids. A blood urea nitrogen (BUN) level of 25 mg/dl (8.9 mmol/l) (normal: 8 to 20 mg/dl; 2.9 to 7.5 mmol/l) is an indication that the client is dehydrated.A serum sodium level of 148 mEq/l (148 mmol/l) (normal: 135 to 145 mEq/l; 135 to 145 mmol/l) is an indication that the client is dehydrated. A blood pressure of 88/56 mm Hg may be an indication of dehydration. A heart rate of 110 beats/min is a compensatory mechanism due to the low blood pressure. Nausea and vomiting in the morning is common in the first trimester. Hyperemesis gravidarum is persistent nausea and vomiting, with weight loss due to the inability to tolerate food or fluids.

During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy?

prepregnancy BMI Explanation: Weight gain goal during pregnancy is based on the client's prepregnant BMI. Current weight and height are part of the BMI calculation. Hemoglobin level only provides information about iron stores, not overall nutritional status.

To prevent exposure to hepatitis A virus, the nurse teaches the pregnant client to avoid which food?

raw fish Explanation: The hepatitis A virus is found in raw fish. Raw eggs and undercooked chicken can transmit salmonella, and swordfish can contain high levels of mercury.

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:

the first day of the last menstrual period. Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.