chapter 15 ob

During labor, a doula is expected to: a. Help the woman do Lamaze breathing techniques and provide support to the woman and her partner b. Check the fetal monitor tracing for effects of the labor process on the fetal heart rate c. Take the place of the father as a coach and support provider d. Administer pain medications as needed by the woman

ANS: A A doula is professionally trained to provide labor support, including physical, emotional, and informational, to women and their partners during labor and birth. The doula does not become involved with clinical tasks.

Which statement about pregnancy is accurate? a. A normal pregnancy lasts about 10 lunar months b. A trimester is one third of a year c. The prenatal period extends from fertilization to conception d. The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth

ANS: A A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks.

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. All women, regardless of risk factors b. A woman who has had more than one sexual partner c A woman who has had a sexually transmitted infection d. A woman who is monogamous with her partner

ANS: A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. All women should be tested for HIV, although this client is at increased risk of contracting the disease. Regardless of sexual history, all women should have an HIV test completed prenatally. Although this client is apparently monogamous, an HIV test is still recommended.

When instructing a pregnant client regarding personal hygiene, it is important for a maternity nurse to be aware that: a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured b. The perineum should be wiped from back to front c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath d. Expectant mothers should use specially treated soap to cleanse the nipples

ANS: A The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra.

6. The quadruple-marker test is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosomal anomalies. The quadruple-marker test will not detect this fetal anomaly. Additional testing, such as ultrasonography is required to diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified during an ultrasound examination. The quadruple-marker test will not detect anencephaly.

Signs and symptoms that a woman should report immediately to her health care provider include (choose all that apply): a. Vaginal bleeding b. Rupture of membranes c. Heartburn accompanied by severe headache d. Decreased libido e. Urinary frequency

ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches are signs of potential complications in pregnancy. Clients should be advised to report these signs to their health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? Choose all that apply. a. Tetanus b. Diphtheria c. Chickenpox d. Rubella e. Hepatitis B

ANS: A, B, E Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Immunization with live or attenuated viruses is contraindicated during pregnancy because of its potential teratogenicity. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

With regard to the initial physical exam of a woman beginning prenatal care, maternity nurses should be aware that: a. Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse b. The woman should empty her bladder before the pelvic examination c. The distribution, amount, and quality of body hair are of no particular importance d. The size of the uterus is discounted in the initial examination because it is just going to get bigger soon

ANS: B An empty bladder facilitates the examination; also, this is an opportunity to get a urine sample easily for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize? a. How the baby will "get out" b. What the baby will eat c. Whether her mother will die d. What color eyes the baby has

ANS: B By age 3 or 4, children like to be told the story of their own beginning and accept it being compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. School-age children take a more clinical interest in their mother's pregnancy and may want to know, "How did the baby get in there?" and "How will it get out?" Whether her mother will die does not tend to be the focus of a child's questions about the impending birth of a sibling. The baby's eye color does not tend to be the focus of children's questions about the impending birth of a sibling.

During the first trimester, a woman can expect which of the following changes in her sexual desire? a. An increase, because of enlarging breasts b. A decrease, because of nausea and fatigue c. No change d. An increase, because of increased levels of female hormones

ANS: B Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters.

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild to moderate intensity. The nurse recommends that she: a. Do Kegel exercises b. Do pelvic rock exercises c. Use a softer mattress d. Stay in bed for 24 hours

ANS: B Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin: a. Before the first missed menstrual period b. After the first missed menstrual period c. After the second missed menstrual period d. After the third missed menstrual period

ANS: B Prenatal care ideally should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prior to missing the first menstrual period is much too early for prenatal care. It is unlikely the woman is even aware of the pregnancy. Ideally prenatal visits should begin soon after the first period is missed. After the third missed menstrual period is much too late to begin prenatal care. The woman will have completed the first trimester by that time.

5. A nurse should advise which women about continued condom use during pregnancy? a. Unmarried pregnant women b. Women at risk for acquiring or transmitting sexually transmitted infections (STIs) c. All pregnant women d. Women at risk for candidiasis

ANS: B The objective of "safer sex" is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and her fetus, condom use is recommended throughout pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice "safer sex" behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. All pregnant women are encouraged to practice "safer sex" behaviors. The client should be educated as to what may place both herself and the fetus at risk. Any pregnant woman might develop candidiasis. This is not related to condom use.

The nurse should be aware that the "pinch" test is used to: a. Check the sensitivity of the nipples b. Determine whether the nipple is everted or inverted c. Calculate the adipose buildup in the abdomen d. See whether the fetus has become inactive

ANS: B The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples. The pinch test is not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

During the initial visit with a client who is beginning prenatal care, nurses should be aware that: a. The first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions b. If nurses observe handicapping conditions, they should be sensitive and not inquire about them because the client will do that in her own time c. Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support d. Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians

ANS: C Besides these potential problems, nurses need to be alert to the woman's attitude toward keeping regular health care appointments. If the client lacks insurance, the nurse may be able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants, and Children [WIC], Medicaid). The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. Nurses must be sensitive to special problems, but they do need to inquire because discovering individual needs is important. People with chronic or handicapping conditions forget to mention them because they have adapted to them. Obtaining information on drug use is important and can be done confidentially. Actual testing for drug use requires the client's consent.

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement accurately applies to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to 12 women are placed in gestational-age cohort groups. d. Outcomes are similar to traditional prenatal care.

ANS: C Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Prior to group sessions, the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, there was a decrease in low-birth-weight (LBW) infants and an increase in breastfeeding rates.

With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that: a. Because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child b. Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other c. Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father d. The woman's sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier

ANS: C Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings. The second trimester is the time when a woman's sense of well-being, along with certain

The nurse should be aware that the partner's main role in pregnancy is to: a. To provide financial support b. To protect the pregnant woman from "old wives' tales" c. To support and nurture the pregnant woman d. To make sure the pregnant woman keeps prenatal appointments

ANS: C The partner's main role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. Although financial support is important, it is not the partner's main role in pregnancy. Protecting the pregnant woman from "old wives' tales" is not the partner's role. The woman's partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy.

Dental care during pregnancy is an important component of good prenatal care. Maternity nurses reinforce this by providing which of the following instructions to their clients: a. Regular brushing and flossing may not be necessary during early pregnancy because it may stimulate the woman who is already nauseated to vomit. A cleaning is all that is necessary b. Dental surgery, in particular, is contraindicated during pregnancy and should be delayed until after delivery c. If dental treatment is necessary, the woman will be most comfortable with it in the second trimester d. If a woman has dental anxiety, dental care may interfere with the expectant mothers' need to practice conscious relaxation and preparation for labor

ANS: C The second trimester is best for dental treatment because that is when the woman will be able to sit most comfortably in the dental chair. Dental care, such as brushing with fluoride toothpaste, is especially important during pregnancy. Periodontal disease has been linked to both preterm labor and low birth weights. Emergency dental surgery is permissible; however, the mother must clearly understand the risks and benefits. Conscious relaxation is useful, and it may even help the woman get through any dental appointments; it is not a reason to avoid them.

A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2011. Her expected date of birth (EDB) is: a. September 17, 2011 b. November 7, 2011 c. November 21, 2011 d. December 17, 2011

ANS: C Using Nägele's rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2011, her due date is November 21, 2011. September 17, 2011, is too short a period to complete a normal pregnancy. Using Nägele's rule, an EDB of November 7, 2011 is 2 weeks early. December 17, 2011, is almost a month past the correct EDB.

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn't know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. a. "Don't worry about it; you'll feel better in a month or so." b. "Have you talked to your husband about how you feel?" c. "Perhaps you really don't want to be pregnant." d. "Hormone changes during pregnancy commonly result in mood swings."

ANS: D

In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one a. To promote family unity b. To ward off the "evil eye" c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy

ANS: D Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the "evil eye" may be specific to one particular culture; however, it is not the primary purpose of these practices.

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: a. Mother of the pregnant woman b. Couple's teenage daughter c. Sister of the pregnant woman d. Expectant father

ANS: D An expectant father's experiencing of his partner's pregnancy-like symptoms is called the couvade syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon. She may be excited about becoming a grandmother or see this as a reminder that she is getting old. A couple's teenage daughter is usually preoccupied with her own sexual development and may have difficulty accepting the overwhelming evidence of her parents' sexual activity. It is the father of the pregnant woman, not the sister, who experiences these symptoms.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach because he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is okay." b. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d. "We do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage."

ANS: D Because monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the woman's sister as her coach with her husband nearby is an acceptable request for a laboring woman.

Many pregnant women have questions regarding work and travel during pregnancy. Nurse should instruct clients that: a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times d. While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so

ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. Vaginal bleeding

ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it usually is not an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be educated that urinary frequency is normal.

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibility b. Fantasizes about the child's gender and personality—views the child as part of herself—becomes introspective c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy d. "I am pregnant"— "I am going to have a baby"—"I am going to be a mother."

ANS: D The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions "I am pregnant," "I am going to have a baby," and "I am going to be a mother" sum up the progression through the three phases. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the child's sex and personality based on fetal activity, occurs during the third phase of attachment.

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. In order to reassure the client regarding fetal well-being it is best for the nurse to: a. Assess the fetal heart tones with a Doppler stethoscope b. Measure the girth of the woman's abdomen c. Complete an ultrasound examination (sonogram) d. Offer the woman and her family the opportunity to listen to the fetal heart tones

ANS: D To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her spouse the chance to listen to their baby's heartbeat. Fetal heart tones can be heard with a fetoscope in the first trimester; by the second trimester, the fetal heart rate can be heard with the Doppler stethoscope. This should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client used consistently. This should be completed at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy

For what reason would breastfeeding be contraindicated? a. Hepatitis B b. Everted nipples c. History of breast cancer 3 years ago d. Human immunodeficiency virus (HIV) positive

ANS: D Women who are HIV positive are discouraged from breastfeeding. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive women should receive the hepatitis B vaccine and immune globulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer is a contraindication to breastfeeding.