Chapter 12: Nursing Management During Pregnancy

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy which statement indicates that the teaching was successful?

Correct response: "I'll get up and walk around the airplane about every 2 hours." Explanation: When traveling by airplane, the woman should get up and walk about the plane every 2 hours to promote circulation. An aisle seat is recommended so that she can have easy access to the aisle. Drinking water throughout the flight is encouraged to maintain hydration. Calf-tensing exercises are important to improve circulation to the lower extremities.

A pregnant woman enjoys exercising at a local health spa once a week. Which comment would lead the nurse to believe she needs additional health teaching?

Correct response: "Nothing feels nicer than a hot sauna after exercise." Explanation: Hyperthermia may be associated with fetal anomalies and should be avoided during pregnancy. Exercise should be limited to low-impact activities.

During a prenatal visit a pregnant woman says "I know the amniotic fluid is important but can you tell me more about it?" When describing amniotic fluid to a pregnant woman which description would the nurse most likely include?

Correct response: "This fluid acts as a cushion to help to protect your baby from injury." Explanation: Amniotic fluid protects the floating embryo and cushions the fetus from trauma. The placenta acts as a transport mechanism for oxygen and nutrients. Amniotic fluid is primarily water with some organic matter. Throughout pregnancy, amniotic fluid volume fluctuates.

A patient is in her 22nd week of pregnancy and is preparing to have her fundal height measured. Given the patient's stage of gestation and following McDonald's rule what result does the nurse expect?

Correct response: 22 cm. Explanation:McDonald's rule, a symphysis-fundal height measurement, although not documented to be thoroughly reliable, is an easy method of determining midpregnancy growth. Typically, tape measurement from the notch of the symphysis pubis to over the top of the uterine fundus as a woman lies supine is equal to the week of gestation in centimeters between the 20th and 31st weeks of pregnancy or in a pregnancy of 22 weeks, for example, the fundal height should be 22 cm.

A pregnant client in her second trimester reports feeling tired all the time. The nurse notes pale skin and low normal hemoglobin on assessment. Which recommendation should the nurse prioritize for this client?

Correct response: An iron supplement. Explanation: Iron is necessary for the formation of hemoglobin; therefore, it is essential to the oxygen-carrying capacity of the blood. Women who have normal hemoglobin may need increased iron to carry more oxygen. Calcium supplementation is essential for normal fetal development. The use of measured supplements would ensure a steady amount, whereas the use of meat and seafood would not allow this.

The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?

Correct response: Arrange for Rho immune globulin at 28 weeks' gestation. Explanation: The nurse should inform the client that Rh-negative mothers should receive Rho immune globulin at 28 weeks' gestation and with antepartum testing to prevent isoimmunization. Positive antibody screens need to be followed up to identify antibodies detected in the blood to prevent fetal complications. The nurse need not make arrangements for blood transfusions, inform the client about the possibility of a cesarean section, or prepare the client for the possibility of a spontaneous abortion.

On the first prenatal visit examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as:

Correct response: Chadwick sign. Explanation: Chadwick sign refers to the bluish coloration of the cervix and vaginal mucosa. Hegar sign refers to softening of the isthmus. Goodell sign refers to softening of the cervix. Homans sign indicates pain on dorsiflexion of the foot.

A pregnant client's last menstrual period was March 10. Using Naegele's rule the nurse estimates the date of birth to be:

Correct response: December 17. Explanation: Naegele's rule can be used to establish the estimated date of birth (EDB). Using this rule, the nurse should subtract 3 months and then add 7 days to the first day of the last normal menstrual period. On the basis of Naegele's rule, the EDB will be December 17 because the client started her last menstrual period on March 10. January 7, February 21, and January 30 are not the EDB according to Naegele's rule.

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

Correct response: Heart disease and diabetes. Explanation: 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.

A pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client?

Correct response: Kegel exercises. Explanation: Women can relieve stress incontinence to some degree by strengthening the perineal muscles through Kegel exercises.

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?

Correct response: Sleep on your side. Explanation: 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.

A nurse is caring for a client who has given birth. The client reports that her breast milk is dark yellow. Which information should the nurse give to the client regarding the situation?

Correct response: The yellow fluid is colostrum and is rich in maternal antibodies. Explanation: The nurse should inform the client that the yellow fluid is called colostrum, and it contains more minerals and protein, but less sugar and fat, than mature breast milk and is also rich in maternal antibodies. The nurse should inform the client that, gradually, the production of colostrum stops and the production of regular breast milk begins, but there is no need to avoid breastfeeding when colostrum is being produced, if the client's culture allows for it. There is no need to modify diet or to feed formula to the infant.

The use of what during pregnancy is potentially most harmful to the fetus?

Correct response: alcohol. Explanation: Chronic or heavy alcohol consumption during pregnancy increases the risk of intellectual disability, learning disabilities, and major birth defects such as those seen in fetal alcohol syndrome. Because alcohol is a potent teratogen and a "safe" level of consumption is not known, women are advised to completely avoid alcohol during pregnancy. Caffeine, aspartame, and Acesulfame-K, if ingested within the recommended limits, are not thought to harm the fetus.

A couple is discussing starting a family with the nurse. When should the nurse suggest genetic counseling?

Correct response: before they conceive. Explanation: The best time for genetic testing is prior to conception. This allows for the couple to discuss risks and plan appropriately.

A pregnant client in her first trimester visits the health care facility for regular checkups. The nurse instructs the client to increase her dietary intake of folic acid based on the understanding that folic acid is important for which action?

Correct response: decreasing incidence of birth defects. Explanation: The nurse should inform the pregnant client that folic acid is important because it decreases the risk of birth defects, including neural tube defects. Folic acid also helps to synthesize DNA and supports placental and fetal growth. Folic acid has no effect on increasing the mother's energy level or resistance to diseases or decreasing her risk of breast cancer.

When describing the process of fertilization the nurse would explain that it normally occurs in which structure?

Correct response: fallopian tube. Explanation: Fertilization normally occurs in the fallopian tube. Once fertilized, the ovum proceeds down the uterus and attaches itself in the endometrium. The vagina and cervix are not involved in fertilization.

A primapara woman 30 weeks' gestation has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment?

Correct response: feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour. Explanation: A woman should report vaginal bleeding, no matter how slight, because some of the serious bleeding complications of pregnancy begin with only slight spotting. Constipation followed by hemorrhoid development is common with pregnancy. Walking up stairs during the third trimester does produce some shortness of breath. It is normal to have some colostrum, or pre-milk, discharge during pregnancy.

The maternal serum alpha fetoprotein blood test is performed on pregnant women to screen for which condition?

Correct response: fetal neural tube defects. Explanation: The maternal serum alpha fetoprotein blood test is performed on pregnant women to screen for fetal neural tube defects. The 1-hour random glucose tolerance test is used to screen for diabetes in pregnant women, and a urine test is used to screen for bladder infections. Different tests are used to screen for sexually transmitted infections.

A woman asks the nurse if she can take an over-the-counter vitamin during pregnancy rather than her prescription prenatal vitamin. A chief ingredient in prenatal vitamins that makes them important for pregnancy nutrition is:

Correct response: folic acid. Explanation: Because folic acid is important during pregnancy to reduce the incidence of spinal cord lesions, prevent abortion, and prevent megaloblastic anemia, it is added at greater strengths to prenatal vitamins.

After teaching a group of adolescent girls about female reproductive development the nurse determines that teaching was successful when the girls state that menarche is defined as a woman's first:

Correct response: menstrual period. Explanation: Menarche is defined as the establishment of menstruation. It does not refer to the woman's first sexual experience, full hormonal cycle, or sign of breast development.

What is the term that refers to a woman who has never been pregnant?

Correct response: nulligravida. Explanation: Gravida refers to the number of pregnancies the woman has had (regardless of the outcome). For example, a woman who has had one pregnancy is a gravida 1, whereas a woman who has had five pregnancies is a gravida 5. A woman who has never been pregnant is a nulligravida, whereas a woman who has had more than one pregnancy is a multigravida.

On a routine hematocrit screen during a prenatal visit the nurse notices that the client is mildly anemic. When discussing this with the couple the husband hints that she might be eating unusual things. The nurse recognizes the need for the woman to be evaluated for which condition?

Correct response: pica. Explanation: Pica is the compulsive ingestion of nonfood substances. Pregnant women who develop a pica habit typically have one or two specific cravings. The three main substances consumed by women with pica are soil or clay, ice, and laundry starch. These substances replace nutritive sources and can lead to complications such as iron-deficiency anemia, infection, and constipation.

The client at 18 weeks' gestation states "I feel a fluttering sensation kind of like gas." The nurse understands that the client is describing what occurrence?

Correct response: quickening. Explanation: The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

A nursing student correctly identifies which action to be the best way to prevent complications of pregnancy?

Correct response: receiving prenatal care. Explanation: Prenatal care is essential for ensuing the overall health of newborns and their mothers. Prenatal care is a major strategy for helping to reduce complications of pregnancy. Limiting work hours is not necessary. Eating a diet high in protein and getting adequate rest (although helpful) will not prevent complications during pregnancy.

A nurse urges a pregnant client at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention?

Correct response: to avoid anemia. Explanation: The increase in the mother's circulatory red blood cell mass requires an additional 400 mg of iron per day or creates a total needed increase of about 800 mg. Iron deficiency can lead to anemia, which is a condition of lower-than-normal levels of red blood cells. Folic acid is taken to prevent megalohemoglobinemia (large, nonfunctioning red blood cells). Iron supplementation does not maintain proper blood glucose levels or reduce the risk for hypertension.