Ch 12: Nursing Care to Promote Fetal and Maternal Health
a) "You should schedule a dental appointment with your dentist now for preventive care, but avoid any nonemergent dental work until after the baby is born" Pg. 259 After being away from routine dental care, the nurse is most correct to encourage dental consultation for this client. The client should continue regular dental care while pregnant but unnecessary dental work should be avoided. Untreated gingivitis can damage the gums, resulting in bone and tooth loss. Treatment is necessary by weighing the risks and benefits. X-rays are not recommended in the first trimester due to the theoretical risk of radiation exposure to the fetus during the embryonic stage. Good oral hygiene includes brushing, flossing, and routine dental visits.
1. A client is 12 weeks' pregnant and asks the nurse about obtaining dental care as she just obtained dental insurance through a new job. Which nursing instruction regarding dental care is an appropriate response? a) "You should schedule a dental appointment with your dentist now for preventive care, but avoid any nonemergent dental work until after the baby is born" b) "Oral health is important, but as long as you brush twice a day, floss regularly, and have no pain, you can wait until after you have the baby to see the dentist" c) "The dentist can make a basic treatment plan to manage your gingivitis following birth. Gingivitis should be treated only after the baby is born" d) "The dentist will obtain a baseline of your oral status. As long as a protective covering is worn, dental x-rays are completely safe in pregnancy"
b) "Try to eat a protein and complex carbohydrate like cheese-on-wheat crackers before exercise" Pg. 260-261 Nutritional support for exercise is important during pregnancy. Advise women to eat a protein and a complex carbohydrate such as peanut butter on whole-wheat bread at least 15 minutes before exercise to keep blood sugar from falling during exercise, and to drink water before and after to prevent dehydration. Snacks are advisable prior to exercise. However, pregnant women should avoid pure carbohydrates and simple sugar snacks like cookies or canned sodas.
10. During prenatal education classes, a woman asks the nurse if she can continue her exercise program during pregnancy. Which information will the nurse provide in terms of keeping blood sugar level adequate throughout the workout? a) "Usually you will not need a snack before working out if you haven't had problems with blood sugars" b) "Try to eat a protein and complex carbohydrate like cheese-on-wheat crackers before exercise" c) "Sugar snacks like cookies will help boost your blood sugar levels before the workout" d) "If you forget to bring a snack, buy a soda from the vending machine before working out"
a) Always consider if there is any body contact associated with others Pg. 257 As a rule, a pregnant client can continue, not avoid, any exercise or sport the client participated in before pregnancy, unless it involves body contact. Exercise does not need to be limited to 20 minutes nor be completed on a flat surface. Exercise can be completed as long as the fetus tolerates the activity well.
11. A client in second trimester of pregnancy asks what guideline to use to determine whether it is safe to participate in a sport or an exercise. Which information will the nurse provide? a) Always consider if there is any body contact associated with others b) Exercise should be limited to the moderate 20 minutes, three times per week format c) Exercise should be avoided in the last trimester d) Exercise should be completed on a flat surface like the floor
a) "I work with copper and lead pipes" Pg. 262-263 The nurse should inform the client that lead is a teratogen that affects the fetal well-being. The teratogens occurring at the workplace are lead and mercury. As long as the pregnancy is progressing without difficulty, the client can carefully climb steps, lift less than 25 lb (11.3 kg), and exercise (e.g., walking). As long as the client feels well, 9,000 steps per day is fine. Common exercise goals are 10,000 steps per day.
19. A pregnant client in the 12th week of gestation expresses a desire to continue employment in a factory. What statement by the client concerns the nurse? a) "I work with copper and lead pipes" b) "I lift approximately 20 lb (9 kg) from a table to a cart" c) "I walk approximately 9,000 steps per day" d) "I climb the steps between the first and second floors"
a) "The enlarging uterus pushes against your diaphragm and this makes breathing shallow" Pg. 269 Increasing levels of progesterone cause relaxation of ligaments and joints. This allows the rib cage to flare to accommodate the enlarging uterus. As the uterus enlarges, it pushes up against the diaphragm. This changes respirations from abdominal to costal, and the woman feels short of breath. The nurse should never demean a client's symptoms. Oxygen requirements do increase during pregnancy, but this not the reason for the woman's shortness of breath.
12. A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? a) "The enlarging uterus pushes against your diaphragm and this makes breathing shallow" b) "Don't worry about this because it is a normal change that occurs with pregnancy" c) "Oxygen requirements are increasing in your body because the fetus is growing" d) "You only have a few more weeks until the birth and then you will breathe fine again"
a) Come to the hospital now for assessment Pg. 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.
13. 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? a) Come to the hospital now for assessment b) Come to the hospital if you are experiencing bloody show c) Come to the hospital once the contractions are 5 minutes apart d) Come to the hospital once your membranes rupture
b) Stopping at least every 2 hours to walk around Pg. It is important to advise a pregnant client who is taking a long trip by automobile to plan for frequent rest or stretch periods. Preferably every hour, but at least every 2 hours, the client should get out of the car and walk a short distance. Pregnant clients may drive automobiles as long as they fit comfortably behind the steering wheel. They should use seat belts like everyone else. Both shoulder harnesses and lap belts should be used. There is no need for the pregnant client to ride in the back seat.
14. A pregnant client and family are planning a trip that requires a 7-hour car ride. Which education will the nurse provide about traveling in a car? a) Making sure to sit in the back seat of the car b) Stopping at least every 2 hours to walk around c) Using the lap belt but not the shoulder harness d) Having other persons drive instead of the pregnant client
a) Avoid wearing high heels, especially during late pregnancy Pg. 269-270 The nurse should ask the client to avoid wearing high heels, especially during late pregnancy because the ligaments relax and the pregnant woman's center of gravity changes; thus, she may lose her balance. The client should avoid a hot tub, sauna, whirlpool, or tanning beds during pregnancy as it can adversely affect the fetus resulting in tachycardia. It can also raise the mother's internal temperature. There is also the possible exposure to bacteria which could result in an infection. The nurse should ask the pregnant woman to consume plenty of fiber and water to prevent constipation and hemorrhoids. If she wakes up feeling very hungry, it could help to eat starchy food, such as a baked potato, just before bedtime. If she eats sweets, she will probably have a rapid rise in blood sugar, followed by a sharp drop. Either of these changes can cause uncomfortable symptoms.
15. A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy? a) Avoid wearing high heels, especially during late pregnancy b) Eat sweets at bedtime to avoid waking up feeling hungry c) Avoid consuming too much fiber in the diet d) Sit in a hot tub for 5 minutes to help ease back pain and leg cramps
b) Elevate legs while sitting Pg. 266 The nurse should encourage the client to elevate her legs while sitting; this will prevent pooling and engorgement of veins in the lower extremities. Aerobic exercises do not help in preventing varicose veins. Folic acid intake is recommended in the first trimester to prevent congenital abnormalities. Increasing the intake of calcium helps in strengthening bones.
16. A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? a) Increase intake of calcium b) Elevate legs while sitting c) Perform aerobic exercises d) Increase intake of folic acid
d) "Acetaminophen is considered relatively safe to take for your headaches during your pregnancy" Pg. 270 The medication that is approved for the treatment of headaches in pregnant women is acetaminophen. Acetaminophen is considered relatively safe to take during pregnancy.
17. A pregnant client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse? a) "Ibuprofen is considered safe to take for your headaches during your pregnancy" b) "You don't want to harm the baby by taking medications now, do you?" c) "Wait until you reach your third trimester. You can take something to relieve headaches then" d) "Acetaminophen is considered relatively safe to take for your headaches during your pregnancy"
a) Smoking 2 packs of cigarettes a day d) Snorting cocaine once or twice a month e) Drinking alcoholic beverages 3 times a week Pg. 271 Often, helping a woman plan to avoid teratogens is challenging because a total change in lifestyle and environment —such as not smoking, not drinking alcohol, or avoiding the use of recreational drugs—may be difficult. Fortunately, most women are highly motivated to complete a pregnancy satisfactorily, so they are usually willing to make changes for the health of the unborn fetus. Working in an office as a receptionist does not expose this client to teratogens. Women are encouraged to continue with their hobbies as long as teratogens are not involved. Painting pictures should not pose a threat to the fetus.
18. During the initial history and physical of a 30-year-old primipara client, the nurse has identified some teratogens the fetus is being exposed to at this phase of the pregnancy. Which lifestyle data could result in teratogenic exposure to the fetus? Select all that apply. a) Smoking 2 packs of cigarettes a day b) Working as a receptionist in a busy office where she copies documents c) Painting pictures as a hobby d) Snorting cocaine once or twice a month e) Drinking alcoholic beverages 3 times a week
b) These contractions are Braxton Hicks, which occur before real labor Pg. 279 Braxton Hicks contractions prepare the body for labor. They are usually irregular in frequency and duration, with fewer than five contractions in 1 hour. They are also short (less than 30 seconds) but may be painful. These contractions may begin as early as the second trimester—especially for clients who have had previous pregnancies—but are more common in the third trimester. They often resolve with position changes, a hot shower, hydration, or relaxation. They are to be differentiated from preterm labor contractions, which are regular, do not resolve with comfort measures, occur more frequently than four contractions in 1 hour, get longer and stronger over time, and result in cervical change. The triage nurse must be able to distinguish between Braxton Hicks and preterm labor contractions. These symptoms are not indicative of a spontaneous abortion (miscarriage) as the contractions are not progressing and regular. Bleeding, pain, and a distended, rigid abdomen are signs of a placental abruption (abruptio placentae).
2. A primigravid at 26 weeks' gestation comes to the clinic with a report of having irregular contractions, lasting less than 30 seconds and occurring no more frequently than five times in 1 hour. The client is afraid of losing the pregnancy. What information will the nurse provide? a) These symptoms indicate that preterm labor is beginning b) These contractions are Braxton Hicks, which occur before real labor c) These are the first symptoms of a placental abruption (abruptio placentae) d) This condition indicates a possible spontaneous abortion (miscarriage) is occurring
b) Sleep on your side Pg. 266 Supine hypotension is a symptom that occurs when a woman lies on her back and the uterus presses on the vena cava, impairing blood return to her heart. A woman experiences an irregular heart rate and a feeling of apprehension. To relieve the problem is simple: if a woman turns or is turned onto her side, pressure is removed from the vena cava, blood flow is restored, and the symptoms quickly fade. To prevent the syndrome, advise pregnant women to always rest or sleep on their side, not their back. Sleeping face down is not advised, and sleeping with the feet elevated would not prevent compression of the vena cava.
20. A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make? a) Sleep with your feet elevated b) Sleep on your side c) Sleep flat on your back d) Sleep face down
a) Decreased birth weight in neonates Pg. 274-275 The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.
21. When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including: a) Decreased birth weight in neonates b) Increased risk of spontaneous abortion (miscarriage) c) Increased risk of placental abruption (abruptio placentae) d) Increased risk of stillbirth
d) Back pain could be a sign of a bladder or kidney infection Pg. 269-270 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. The other causes of back pain listed do not warrant as much immediate concern as the possibility of a bladder or kidney infection.
22. A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? a) Back pain could be a sign of degenerated discs b) Back pain could be a result of improper lifting c) Back pain could be a result of a soft mattress d) Back pain could be a sign of a bladder or kidney infection
a) The steroids speed up the development of the lungs Pg. 183 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.
23. 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? a) The steroids speed up the development of the lungs b) The steroids will help to slow the development of infection c) The steroids will increase the baby's muscle mass d) The steroids will create a layer of fat to help with temperature regulation
b) Avoid medications Pg. 271-275 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).
24. 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? a) Eat a well-balanced diet b) Avoid medications c) Maintain personal hygiene d) Avoid intake of coffee
b) Colostrum from the nipples Pg. 259 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.
25. While assessing a client's breast during the third trimester, which finding would the nurse expect? a) Pink-colored nipples b) Colostrum from the nipples c) Pain in the nipple area d) Breasts becoming soft
d) Inspection Pg. 274 With the information that the newborn may have been exposed to alcohol in utero, the nurse will use the assessment skill of inspection to identify craniofacial deformities. Craniofacial deformities include short palpebral fissures, a thin upper lip, and an upturned nose. There is no need for auscultation, palpation, or percussion.
37. The nurse is caring for a newborn whose pregnant parent drank an undetermined amount of alcoholic beverages. Which assessment technique does the nurse use to identify if the newborn has common findings of fetal alcohol spectrum disorder? a) Percussion b) Auscultation c) Palpation d) Inspection
d) "It may be Braxton Hicks contractions. Continue to monitor what you are feeling, and let me know how it changes" Pg. 279 The nurse is correct to assess the symptoms as presented and counsel the woman that the symptoms are in alignment with Braxton Hicks contractions. Braxton Hicks contractions are painless uterine contractions that can be felt as early as 8 weeks and are not a matter of concern. However, if these contractions become rhythmic, increase in frequency, or become painful, they need to be evaluated. There are no signs of dehydration in the question. A pregnancy at 38 weeks' gestation is considered full-term.
26. A woman at 38 weeks' gestation reports a nonpainful tightening and pulling sensation on the uterus for 30 seconds. She states it has been happening 2 to 4 times an hour over the past three hours. She is concerned she is in labor. How would the nurse counsel this client? a) "You are experiencing contractions, and because you are not yet at term, you need to come in right away" b) "You are at the beginning of labor but can wait at home until the contractions get stronger and more consistent" c) "These are symptoms of dehydration. Drink 8 ounces of water and lie down; it should go away" d) "It may be Braxton Hicks contractions. Continue to monitor what you are feeling, and let me know how it changes"
b) It is caused by increased estrogen levels and should disappear in time Pg. 265 Palmar erythema, or palmar pruritus, occurs early in the pregnancy and is probably caused by increased estrogen levels. Constant redness or itching of the palms can make a client believe they have developed an allergy. Instruction that this type of itching in early pregnancy is normal and relieves the client's anxiety. The client may find lotion to be soothing and can continue without fear. As soon as a client's body adjusts to the increased level of estrogen, the erythema and pruritus disappear. This condition is not a sign of vascular congestion or high blood pressure.
27. A client reports constant redness and itching of the palms early in the pregnancy. The client fears that they are suffering an allergic reaction. Which instruction will the nurse provide? a) It is a sign of high blood pressure. You may need to be started on an antihypertensive drug b) It is caused by increased estrogen levels and should disappear in time c) It is likely an allergic reaction to a lotion. The body is more sensitive during pregnancy d) It is a sign of capillary leakage from the increase in blood volume
c) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding Pg. 259 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.
28. 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? a) Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus b) Long soaks in very hot water are encouraged during pregnancy to promote relaxation c) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding d) Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus
d) Rest on the left side for at least 1 hour in the morning and afternoon Pg. 261 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.
29. A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? a) Perform nipple exercises and stimulation on a regular basis b) Apply lanolin ointment to the nipple and areola to prevent cracking c) Take a hot water bath or shower daily to maintain hygiene d) Rest on the left side for at least 1 hour in the morning and afternoon
c) Purchase a padded supportive bra to wear under your clothing Pg. 259 The breasts prepare for breastfeeding even before birth of the infant. At about the 16th week of pregnancy, colostrum secretion begins in the breasts. The best suggestion is to wear a padded, supportive bra that can absorb the leakage without it coming through the clothing. Having a change of clothes does not prevent the problem, and it may be noticeable that clothing has been changed. Limiting fluid intake is not suggested. The pregnant woman needs to remain hydrated. Placing tape on the nipples may harm the nipples and, although accepted in a few cultures, is discouraged.
3. A primigravid client states that she has heard that her nipples will leak milk during the pregnancy and is concerned of embarrassment if this should happen while she is at work. Which nursing suggestion is best? a) Limit fluid intake to prevent the production of milk prior to childbirth b) Have a change of clothing available in case the milk leakage happens c) Purchase a padded supportive bra to wear under your clothing d) Place tape on your nipples to prevent nipple leakage while at work
d) Disturbed sleep pattern related to frequent movement of fetus at night Pg. 265 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.
36. 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? a) Fatigue related to increased need for rest during pregnancy b) Acute, intense pain related to frequent kicking by the fetus c) Health-seeking behaviors related to client request for a sleep medication d) Disturbed sleep pattern related to frequent movement of fetus at night
c) Smoking during pregnancy limits the supply of blood to the fetus Pg. 274 The nurse is correct to provide instruction and guidance on the effects of smoking during pregnancy. It is most important for the client to understand that smoking during pregnancy limits the blood supply to the fetus due to the vasoconstrictive effects of the nicotine. This may result in a stillborn or low-birth-weight newborn. In addition, the placenta may be less effective due to the effect of tar in the system, again limiting blood supply. The heart and lungs of the fetus may be impacted primarily by the poor circulatory effect. Depending upon the ability of oxygen to get to the fetal brain, cognitive impairment may also be identified due to the circulatory effect.
30. A primigravid client arrives at the health clinic smelling like they had been recently smoking a cigarette. Upon assessing the client for tobacco use, the client states, "I know people who smoked during their pregnancy and their babies were fine." When assisting the client to understand the most concerning impact of smoking on the fetus, the nurse is correct to state which? a) Smoking during pregnancy impacts the heart valves of the fetus b) Smoking during pregnancy causes a lower intelligence level of the fetus c) Smoking during pregnancy limits the supply of blood to the fetus d) Smoking during pregnancy damages the fetal lungs
c) "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection" Pg. 260 Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.
31. A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time? a) "Let's discuss this with your health care provider before you continue douching" b) "If you prepare your own douching solution, be sure to boil the water to kill bacteria" c) "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection" d) "Douching will definitely keep your vagina clean"
c) Engage in regular exercise such as walking to promote venous return d) Rest several times daily with legs elevated to promote venous return e) Avoid prolonged periods of sitting throughout pregnancy Pg. Varicose veins more commonly occur in clients experiencing obesity. Preventive measures include avoiding prolonged periods of sitting and standing, engaging in regular exercise to promote venous return, and resting with legs elevated to promote venous return. Support stockings may be used, but knee-high stockings are not recommended, because they occlude the veins at the knee and increase the risk of varicose veins in the lower leg. Weight loss during pregnancy is not recommended; clients experiencing obesity still need to gain weight to promote fetal growth.
32. A client whose body mass index classifies as obese asks the nurse about prevention measures for varicose veins in pregnancy. What measure(s) will the nurse include in the education? Select all that apply. a) Aim for a 5 to 10 lb (2.3 to 4.5 kg) weight loss in the first trimester b) Wear knee-high support stockings to prevent venous pooling c) Engage in regular exercise such as walking to promote venous return d) Rest several times daily with legs elevated to promote venous return e) Avoid prolonged periods of sitting throughout pregnancy
b) Avoid sports that involve body contact c) Avoid taking up a new sport, such as cycling, during pregnancy d) Exercise for 30 minutes per day 5 days per week e) Include warm-up and cool-down exercises f) Try walking, which is an excellent exercise option during pregnancy Pg. 260-261 As a rule, average, well-nourished women should exercise during pregnancy about 5 times weekly for 30 consecutive minutes. Their exercise program should consist of 5 minutes of warm-up exercises, an active "stimulus" phase of 20 minutes, and then 5 minutes of cool-down exercises. Movements that exercise large muscle groups rhythmically, such as walking, are best, but the type of activity chosen should depend on their interests. She should avoid sports that involve body contact, taking up a new sport, and jogging, all of which would put her at greater risk for injury.
33. A physically fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. The woman normally jogs, but has been thinking about taking up cycling. The woman also would like to know how much exercise is recommended. Which instruction(s) will the nurse give to the woman? Select all that apply. a) Avoid exercises that involve movements of large muscle groups rhythmically b) Avoid sports that involve body contact c) Avoid taking up a new sport, such as cycling, during pregnancy d) Exercise for 30 minutes per day 5 days per week e) Include warm-up and cool-down exercises f) Try walking, which is an excellent exercise option during pregnancy
d) They are not rated with regard to safety during pregnancy Pg. 274 Herbs are not regulated by the FDA in the same way as medications; therefore, they are not rated with regard to their safety in pregnancy. As with medicine, women should not take herbs in pregnancy until they discuss the herbs' safety with their obstetric provider. Herbal supplements do not create nutritional deficiencies in the fetus and are not known that herbal supplements cause teratogenic effects in the fetus. There is no proof that herbal supplements cause early labor.
34. A pregnant woman asks the nurse about using herbal remedies while she is pregnant. The nurse recommends that the woman talk with her health care provider about their use based on which understanding? a) They can create nutritional deficiencies in the mother and fetus b) They have been proven to cause early labor c) They are known to cause teratogenic effects in the fetus d) They are not rated with regard to safety during pregnancy
d) Tingling sensations and tenderness Pg. 265 Normal changes in the breasts associated with pregnancy include tingling sensations and tenderness, enlargement of the breast and nipples, hyperpigmentation of the areola and nipples, enlargement of Montgomery glands (Montgomery tubercles), prominence of superficial veins, development of striae gravidarum (stretch marks), and expression of colostrum in the second and third trimesters.
35. Which change in the breasts should a nurse recognize as a normal change associated with pregnancy? a) Hypopigmentation of the areola and nipples b) Expression of colostrum in the first trimester c) Disappearance of superficial veins d) Tingling sensations and tenderness
b) "When I first urinate in the morning, I notice a burning sensation, but then as I am constantly going throughout the day, it goes away" Pg. 268 It is important for the nurse to screen the client for both normal changes of pregnancy and complications. Urinary tract infections (UTIs) in pregnancy are common and warrant treatment. Often a pregnant woman will have no symptoms or very mild symptoms of a UTI. Other symptoms such as fatigue, palmar erythema, and muscle cramps are common discomforts in the first trimester.
38. A pregnant client in the first trimester comes to the clinic for a visit. Which statement leads the nurse to suspect that the woman is experiencing a complication of pregnancy that requires additional follow-up? a) "When I get up in the morning, I feel good, but throughout the day, my palms get red and itchy" b) "When I first urinate in the morning, I notice a burning sensation, but then as I am constantly going throughout the day, it goes away" c) "Last night, I woke up in the middle of the night with this intense leg pain that subsided after a few seconds. Today, my leg still feels sore" d) "I am so tired. As soon as I get home from work, I go to bed. I used to go to bed at 10:00 pm and now I have to go to bed at 8:00 pm"
a) Sudden gush of clear fluid coming from the vagina d) Pain in back that wraps across the abdomen and increases in frequency and intensity e) Pink-tinged blood and mucus mixture on underwear Pg. 278-280 True labor contractions usually begin in the back and sweep forward across the abdomen similar to the tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy is expelled. The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. This blood, mixed with mucus, takes on a pink tinge and is referred to as "show" or "bloody show." Labor may begin with rupture of the membranes, experienced either as a sudden gush or as a scanty, slow seeping of clear fluid from the vagina. Leaking colostrum from the nipples can occur throughout the pregnancy. Occasionally, a woman notices urinary incontinence (involuntary loss of urine on coughing or sneezing) during pregnancy.
39. A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving the unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman associate with true labor? Select all that apply. a) Sudden gush of clear fluid coming from the vagina b) Urine leakage after coughing or sneezing c) Leakage of white to yellow discharge from the nipples d) Pain in back that wraps across the abdomen and increases in frequency and intensity e) Pink-tinged blood and mucus mixture on underwear
b) Wear support hose Pg. 267 The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight.
4. A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight? a) Wear a padded bra b) Wear support hose c) Wear low-heeled shoes d) Wear cotton clothes
c) The client reduces her smoking by 50 percent by the next clinic visit Pg. 274-275 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.
40. 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? a) The client throws the cigarettes in the trash immediately b) The client does some research on the harmful affects of cigarette smoking on the baby c) The client reduces her smoking by 50 percent by the next clinic visit d) The client stops smoking immediately for the health of the fetus
c) The client is having growing pains Pg. 268 In the first trimester, sharp pains in the lower abdomen are common. Stretching of the round and broad ligaments that support the growing uterus causes them, which are usually very short (< 5 seconds) and have a stabbing quality. They are not repetitive but are often associated with position changes or, later, fetal movements. The nurse would not document this finding as spontaneous abortion (miscarriage), preterm labor, or Braxton Hicks contractions.
41. The nurse is assessing a 27-year-old woman pregnant for the first time during her initial visit to the obstetric clinic. The client is currently at 8 weeks' gestation. During the assessment, the client reports that she is experiencing sharp stabbing pains in her lower abdomen, especially when she changes position. How would the nurse document this finding? a) The client is having a spontaneous abortion (miscarriage) b) The client is having preterm labor c) The client is having growing pains d) The client is having Braxton Hicks contractions
c) The flu vaccine, after the first trimester of pregnancy is complete Pg. 265 The nurse assesses the vaccination status during the first prenatal visit to determine potential complications during pregnancy. It also gives the nurse the opportunity to teach the client about vaccinations, which can provide protection to the newborn after birth by the formation of antibodies. The flu shot is safe and encouraged during pregnancy. Live viruses vaccines such as MMR, varicella, and HPV are contraindicated in pregnancy.
42. The nurse is assessing the past history of a woman at her first prenatal appointment. If the woman has no history of vaccination of the choices listed, which vaccine would the nurse schedule this client to receive? a) The human papillomavirus vaccine, if younger than 26 years of age b) The measles vaccine, during the woman's second trimester c) The flu vaccine, after the first trimester of pregnancy is complete d) The varicella vaccine, before she reaches 36 weeks' gestation
c) "During the last month, rest on the left side for at least an hour, morning and afternoon" Pg. 261-266 During the pregnancy's last months, the woman should 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 the flow of oxygenated blood to the fetus. There is no proof that a tub bath introduces infection or is harmful to the fetus. If breastfeeding, the woman should bathe as normal, but avoid using soap on the nipples. The woman should also avoid sleeping on her back to avoid supine hypotension syndrome.
5. The nurse is teaching a pregnant client in her last trimester about personal care interventions to help reduce the risks of complications late in pregnancy. Which topic for instruction will the nurse include? a) "If planning to breastfeed, bathe as normal using soap and water on the nipples" b) "Sleep on your back each night to avoid supine hypotension syndrome" c) "During the last month, rest on the left side for at least an hour, morning and afternoon" d) "Take a daily shower, avoiding a tub bath because this could introduce infection"
c) Acetaminophen Pg. 270 Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.
6. A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain? a) Ibuprofen b) Naproxen c) Acetaminophen d) Aspirin products
b) Maintain tolerable intensity of exercise Pg. 261 Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.
7. A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? a) Begin a new exercise regimen b) Maintain tolerable intensity of exercise c) Reduce the amount of exercise d) Wear support hose when exercising
a) "You will have an ultrasound done to check for chromosomal problems" d) "The provider will check the amount of fluid in the space behind your fetus's neck" Pg. 163 Nuchal translucency screening is an ultrasound that is done in the first trimester between 11 and 14 weeks' gestation. This allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities. It measures fluid collection in the subcutaneous space between the skin and the cervical spine of the fetus. Blood sampling may be done to check for maternal markers that could indicate problems. Amniocentesis involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth. In addition, amniocentesis is used to confirm a fetal abnormality when other screening tests detect a possible problem. Chorionic villus sampling (CVS) is an invasive procedure involving an 18-gauge needlestick through the abdomen or passage of a suction catheter through the cervix under ultrasound guidance. This test is used to obtain a sample of the chorionic villi from the placenta for prenatal evaluation of chromosomal disorders such as Down syndrome or cystic fibrosis, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay-Sachs disease.
8. A pregnant woman who has come to the clinic for an evaluation is scheduled to undergo nuchal translucency screening. The woman asks the nurse, "What is this test all about?" Which response(s) by the nurse would be appropriate? Select all that apply. a) "You will have an ultrasound done to check for chromosomal problems" b) "You will have blood drawn to check for substances associated with abnormalities" c) "This test involves an amniocentesis to check for genetic abnormalities" d) "The provider will check the amount of fluid in the space behind your fetus's neck" e) "A needle is inserted into your belly to get a sample of cells from the placenta"
c) Try relaxation exercises at bedtime Pg. Relaxation or mindfulness exercises may help with falling asleep. Large meals may increase heartburn in late pregnancy, which can interfere with sleep due to discomfort; therefore, large meals are not recommended. Napping or an afternoon rest period may be required to ensure adequate rest and sleep. An over-the-counter sleep aid should not be recommended without further consultation.
9. A client at 34 weeks' gestation reports difficulty sleeping at night. What will the nurse recommend? a) Use an over-the-counter sleep aid b) Avoid napping to improve quality of nighttime sleep c) Try relaxation exercises at bedtime d) Eat a large evening meal to prevent hunger during the night
