Chapter 5 OB
A multiparous woman in her 28th week of pregnancy comes to her prenatal appointment in tears, stating that she is overwhelmed. which would be the most therapeutic response by the nurse? "I can see you are feeling overwhelmed. Tell me more about that." "There is no reason to feel overwhelmed, you've done this before." "Clients always feel overwhelmed at some point of their pregnancy." "It sounds like you have a lot on your plate. Maybe your husband should help out more with the other kids."
"I can see you are feeling overwhelmed. Tell me more about that."
The nurse is caring for a primiparous client in her first trimester. which information regarding sexual intercourse is most important for the nurse to include in teaching this client? "All women's sexual desire changes when they get pregnant, due to the rising levels of estrogen." "You may need to modify intercourse positions for your comfort." "Your genitals may change after the birthing process." "You should abstain from sexual intercourse if you are having vaginal bleeding."
"You should abstain from sexual intercourse if you are having vaginal bleeding."
Which client would you anticipate to encounter difficulties, such as language barriers and monetary struggles, during their pregnancy? A woman diagnosed with preeclampsia An adolescent A woman who recently immigrated to the United States A veteran who recently served in Iraq
A woman who recently immigrated to the United States
A pregnant client tells the prenatal nurse she feels unsupported by her husband. which nursing action is most important for this client? Select all that apply. Advise the woman how best to use her existing support networks. Encourage the woman to tell her family they are not being supportive enough. Tell the woman she should leave her husband if he is not being supportive. Advise the woman how to expand her support network so her needs are met. Assist the woman and her husband to find a family counselor.
Advise the woman how best to use her existing support networks. Advise the woman how to expand her support network so her needs are met.
A nurse is teaching a pregnant client with schizophrenia about the care required during pregnancy. Which is the priority nursing action for the nurse? Assess the woman's mood, anxiety, and emotional state. Discuss expectations about pregnancy, childbirth, and parenting. Educate the client on potential side effects of psychotropic medications. Determine if the client has adequate support systems in place.
Assess the woman's mood, anxiety, and emotional state.
When caring for a newly widowed client in her second trimester, which must the perinatal nurse understand the importance of? Educating the woman about the quad screen Assisting the woman to develop a birth plan Assessing the woman's level of stress and anxiety Assisting the woman to obtain financial assistance
Assessing the woman's level of stress and anxiety
The nurse is assessing a pregnant client's mood, emotional state, and anxiety. which is the priority action by the nurse? Ensure the woman is taking her anti-psychotic medication. Tell her she should consider adoption since she is not mentally capable of caring for a baby. Refer her to her psychiatrist for evaluation. Consider how frequently the episodes occur, how long they last, and what caused them.
Consider how frequently the episodes occur, how long they last, and what caused them.
The nurse notices a client is commonly late for her prenatal appointments. which is the most likely explanation? Her clock at home is 5 minutes slow Her culture has a different concept of time She is using drugs She does not understand the importance of prenatal care
Her culture has a different concept of time
The prenatal nurse is caring for an elderly primiparous client at her first prenatal appointment. It is most important the nurse provide the client with information regarding: Screening for chromosomal abnormalities Group beta strep testing Prenatal classes at the local hospital Adoption agencies in the area
Screening for chromosomal abnormalities
A nurse is caring for a G1P1 lesbian client 24 hours post vaginal delivery. When preparing the client and her partner to discharge from the hospital, it is most important for the postpartum nurse to provide education regarding: Reproductive health Postpartum depression Newborn care Stress management
Newborn care
A nurse is caring for a client in her third trimester. Which actions by the client would necessitate further evaluation by the nurse? The woman develops realistic expectations of labor and birth. The woman does not attend child birth classes or read books about labor and birth. The women deep cleans and organizes her house a few weeks prior to her due date. The woman does not mentally rehearse or fantasize about labor.
The woman does not attend child birth classes or read books about labor and birth.
The nurse is caring for a pregnant client with bipolar affective disorder. Which information is important for the nurse to understand regarding mental health disorders in pregnancy? Select all that apply. A. Mental health issues during pregnancy always create problems for the pregnant woman. B. The client may show difficulty with taking on the maternal role. C. It is the role of the social worker to collaborate with community agencies and psychiatric facilities. D. Prenatal depression and anxiety can negatively affect the growing fetus. E. Psychiatric medications are not safe for pregnant women to take and should be discontinued right away.
B. The client may show difficulty with taking on the maternal role. D. Prenatal depression and anxiety can negatively affect the growing fetus.
A client who is a G2P0 tells the nurse she wants to be seen by a healthcare provider who is not a physician, but has advanced training in pregnant clients. which care-provider would the nurse recommend? Lay midwife Direct entry midwife Certified Nurse-Midwife (CNM) Doula
Certified Nurse-Midwife (CNM)
The perinatal nurse is caring for a client who has been missing her prenatal appointments. which information is most important for the nurse to understand? Cultural practices can influence the pregnant woman's use of health care services. The woman will not attend prenatal classes if they are only offered in English. Prenatal vitamins are viewed as harmful in some cultures. Confidence in healthcare providers and their recommendations is a shared belief across cultures.
Cultural practices can influence the pregnant woman's use of health care services.
A nurse is caring for an adolescent primiparous client in her first trimester. Which is the highest priority for this client? Deficient knowledge related to pregnancy psychosocial and emotional change Risk for injury related to the birthing process Decreased gastric motility related to normal physiologic pregnancy changes Risk for infection related to group beta strep colonization
Deficient knowledge related to pregnancy psychosocial and emotional change
A client tells the nurse she wants to attend childbirth education classes that focus on the prevention of pain during labor and birth. which recommendation can the nurse provide to the client? Select all that apply. Dick-Read Lamaze Bradley Doula La Leche League
Dick-Read Lamaze Bradley
A nurse is caring for a client from another country during her first pregnancy. which information is important for the nurse to understand regarding the client's view of obstetric care practiced in North America? It is safe and effective. It is strange and confusing. It is expensive and unnecessary. It is new and different.
It is strange and confusing.
A client reports decreased interest in sexual activity during her pregnancy. Which statements made by the nurse are true regarding sexual interest and activity during pregnancy? Select all that apply. "All of the changes happening in your body can affect your sexual desires and responses." "You may find yourself wanting to have sex more often as the end of the pregnancy draws near." "Sometimes pregnant women feel more beautiful and desirable as the pregnancy advances." "It is important for us to discuss how your sexual desire and activity is being affected by the pregnancy." "During the second trimester, you may see an even further decrease in your sexual interest."
"All of the changes happening in your body can affect your sexual desires and responses." "Sometimes pregnant women feel more beautiful and desirable as the pregnancy advances." "It is important for us to discuss how your sexual desire and activity is being affected by the pregnancy."
A pregnant client has experienced a 10 lb weight gain in the first 6 months of her pregnancy. During a routine prenatal appointment, the woman begins crying and states that she feels fat and undesirable. which would be the most therapeutic response by the nurse? "You are beautiful. Please don't be too hard on yourself." "Your weight gain so far is appropriate for your pre- pregnancy weight." "I can see you are upset. Have you discussed your concerns with your partner?" "I know how you are feeling. I felt like that when I was pregnant as well."
"I can see you are upset. Have you discussed your concerns with your partner?"
A clinic nurse is evaluating a pregnant client at her first prenatal appointment. Which statement made by the client most warrants further questioning? "I have not been taking my prenatal vitamins because they make me sick." "I vomit constantly." "I have depression and have a history of suicidal attempts." "I am feeling really unsure about this pregnancy. I don't know if I am ready."
"I have depression and have a history of suicidal attempts."
The perinatal nurse is caring for a client being seen for selective reduction of a quadruplet pregnancy. Prior to the procedure the client begins sobbing uncontrollably. which would be the most therapeutic response by the nurse? "I see you are having a difficult time with this. Let's take some time to discuss how you are feeling." "This is the right decision. It will be better for the remaining fetuses." "Selective reduction is an extensively invasive procedure and will take several hours." "Why are you crying? Do you need to go home and come back another day?"
"I see you are having a difficult time with this. Let's take some time to discuss how you are feeling."
A 36-week pregnant client tells the nurse that no males are allowed to enter her room when she is in labor. which is the most therapeutic response by the nurse? "I understand you feel strongly about this. I will do everything possible to ensure your needs are met." "There is a chance a male obstetrician will be on call when you go into labor. Have you talked to your OB- GYN about this?" "I cannot promise you will have a female doctor deliver your baby." "It is acceptable for a male doctor to see your genitals during childbirth."
"I understand you feel strongly about this. I will do everything possible to ensure your needs are met."
A pregnant client tells the nurse her school-age daughter wants to be present for the birth of her baby brother. which is the best response by the nurse? Select all that apply. "If your daughter is going to be present for the birth, she should attend a class to prepare her." "It is not recommended that children of her age be present at the birth." "That is a great idea. It will help her bond with her new brother right away." "I wouldn't do that if I were you. My daughter was traumatized from watching me give birth to my son." "A familiar person should be designated to explain what is happening and comfort her if she becomes overwhelmed."
"If your daughter is going to be present for the birth, she should attend a class to prepare her." "A familiar person should be designated to explain what is happening and comfort her if she becomes overwhelmed."
A client that is G2P1 at 30 weeks gestation is being educated at a routine prenatal appointment. which information would be the most important for the nurse to include in a discussion about sibling adaptation in regards to her 3-year-old daughter? "If your other child is still sleeping in a crib you may want to consider changing their sleeping arrangements within the next two weeks." "It may take a few weeks for your daughter to show interest in the new baby." "Your daughter will probably feel jealous of the new baby. You need to make sure to give her special attention." "Your daughter is young enough that she will probably not be phased by the new baby."
"If your other child is still sleeping in a crib you may want to consider changing their sleeping arrangements within the next two weeks."
A pregnant client discloses to the nurse that her husband has recently started being physically abusive. which would be the most therapeutic response by the nurse? "It is rare for abuse to start in pregnancy. Are you sure he has never hit you before?" "I am so sorry. For the safety of yourself and your baby, you should leave him." "It is not uncommon for abuse to begin or get worse during pregnancy. Do you want to talk about your options?" "I am legally obligated to call the police and report your husband."
"It is not uncommon for abuse to begin or get worse during pregnancy. Do you want to talk about your options?"
During a prenatal visit, the client's husband states he has been experiencing nausea, weight gain, and abdominal pains. which is the best response by the nurse? "Men may experience pregnancy-like symptoms similar to those of their partner." "It is common for men to experience physical symptoms at the same time as their partner." "Because you are a middle-aged man, you should be screened for colon and prostate cancer." "The increased estrogen levels in your wife can transfer to you; mimicking pregnancy symptoms."
"Men may experience pregnancy-like symptoms similar to those of their partner."
A prenatal nurse is caring for a client that is G4P1. Which statement by the client indicates an appropriate response of her 3-year-old to their mother's progressing pregnancy? "My daughter seems unaware of the pregnancy." "My daughter is constantly asking the same questions month to month about my enlarging abdomen." "My daughter wants to know how I got pregnant and what will happen at the birth." "My daughter has been throwing temper tantrums because I can no longer lift or carry her."
"My daughter is constantly asking the same questions month to month about my enlarging abdomen."
A pregnant client tells the nurse she is concerned about how her older child will react to the birth of the new baby. Which would be the most therapeutic response by the nurse? "Sharing the spotlight with a new sibling can be a major crisis for a child. How old is your other child?" "All pregnant women feel this way when there is another child involved. It is a normal." "Children younger than 2 are usually aware of the pregnancy." "Would you like me to refer you to a family counselor so you can discuss your concerns?"
"Sharing the spotlight with a new sibling can be a major crisis for a child. How old is your other child?"
A pregnant client is upset because her parent's reaction to her pregnancy was not what she was expecting. which is the best response by the nurse? "Pregnant women are hormonal and often have heightened sensitivity to things like this." "Some grandparents may respond negatively because the pregnancy is undeniable evidence they are growing older." "Grandparents may react negatively to news of the pregnancy if they do not agree with the woman's decision to have children." "Grandparents expect to be the first family members told about a pregnancy and will always be upset if they are not."
"Some grandparents may respond negatively because the pregnancy is undeniable evidence they are growing older."
A 10-week pregnant client verbalizes feelings of ambivalence about her pregnancy. Which would be a therapeutic response by the prenatal nurse? "These feelings are common during the first trimester and should decrease as your pregnancy progresses." "Most women experience ambivalent feelings their entire pregnancy." "You should be excited about the pregnancy as it is a wonderful experience to bring new life into the world." "I am going to refer you to a psychologist for prenatal depression."
"These feelings are common during the first trimester and should decrease as your pregnancy progresses."
The nurse is performing assessments on postpartum clients on the unit. Which client is identified by the nurse as requiring the Edinburgh Postnatal Depression Scale? A 40-year old G3P2 who delivered last week after a repeat Cesarean Section A 16-year old G2P1 who is 24 hours postpartum vaginal delivery A 29-year old G1P1 veteran who delivered 4 weeks ago and has a history of depression A 32-year old G1P1 lesbian woman who delivered 2 weeks ago and has a history of mild anxiety
A 29-year old G1P1 veteran who delivered 4 weeks ago and has a history of depression
A clinic nurse is caring for multiple clients. Which client does she identify as high risk for experiencing a teenage birth? A client who dropped out of high school A client who smokes cigarettes A client whose parents are divorced A client who uses recreational drugs
A client who dropped out of high school
During her prenatal appointment, a woman's preschool-age daughter asks if she can listen to the fetal heartbeat. The nurse interprets the child's behavior as? An unexpected finding, as children this age are not usually interested in the pregnancy A cry for attention due to her mom being preoccupied by the pregnancy Over-enthusiasm and something that should be discussed with the child before the arrival of the baby A normal response of the child, according to their age
A normal response of the child, according to their age
A nurse is caring for a 13-year-old pregnant client experiencing her first pregnancy. which is the highest priority for this client? Assess for bruises at multiple stages of healing. Evaluate the client's capability of abstract thinking. Assist the client in understanding consequences of current behaviors. Reinforce the importance of the client being an active participant in health care decisions.
Assess for bruises at multiple stages of healing.
The nurse is caring for a pregnant adolescent client during a prenatal visit. Which nursing action is a priority for this client? Offer advice on smoking cessation. Give the client information about adoption. Assess for bruises in different stages of healing. Determine what type of birth control the client plans to use after she gives birth.
Assess for bruises in different stages of healing.
Which nursing action is most important when caring for the parents of an incarcerated pregnant woman who will be assuming care of the newborn? Assess the grandparents' response to the pregnancy. Explore the grandparents as a resource during pregnancy and early parenting. Involve social services so they can assess the grandparents' financial resources. Evaluate the grandparents' response to the reality they will be caring for a newborn.
Assess the grandparents' response to the pregnancy.
A nurse is counseling an adolescent client who presented to the clinic for her first prenatal visit. She reports she is currently living alone and the father of the baby is no longer involved. When developing the plan of care for this client, which priority outcome is identified? Report increasing acceptance of changes in body image. Discuss fears related to labor and birth. Identify appropriate emotional support systems. Develop a realistic birth plan.
Identify appropriate emotional support systems.
A nurse is caring for a 30-year-old G4P2 client. She arrives at the clinic for her first prenatal visit with her husband and stepchildren. When discussing family adaptation, what developmental tasks should be included? Select all that apply. Delegating household chores and tasks after the baby is born Purchasing diapers, wipes, bottles, and other baby care items Reorienting of relationships with relatives Expanding communication to meet emotional needs Preparing a birth plan that includes all members of the family
Delegating household chores and tasks after the baby is born Purchasing diapers, wipes, bottles, and other baby care items Reorienting of relationships with relatives Expanding communication to meet emotional needs
The nurse notices a client's husband commonly interrupts her and rarely lets her answer questions when asked. which is the priority action by the nurse? Tell the husband he needs to leave the room for the remainder of the appointment. Document the findings in the client's record. Ask the husband why he is answering the questions for his wife. Call security and have them escort the husband off the premises.
Document the findings in the client's record.
When discussing family dynamics with a client who is G1P0, the client tells the nurse she currently lives with her husband, whom has no other children. The nurse recognizes this as which type of family structure? Extended family Nuclear family Dyad family Typical family
Dyad family
The nurse is performing an assessment for a client with a high-risk pregnancy. Which screening tool is most important for this client? Fetal Fibronectin Test (fFN) Edinburgh Postnatal Depression Scale DSM-IV Vanderbilt Diagnostic Rating Scale
Edinburgh Postnatal Depression Scale
Which barriers might an American-born nurse face when caring for a client of a different nationality? Select all that apply. Egocentrism Ethnocentrism Stereotyping Communication Knowledge deficit
Ethnocentrism Stereotyping Communication
A nurse is caring for a Filipino woman in her third trimester. Which information is most helpful in providing culturally responsive care? Only Western cultures recognize childbirth as a time of great celebration. Every culture has a set of behaviors, beliefs, and practices that influence a woman during childbearing. The woman has most likely incorporated the practices of American culture into her way of life. Childbirth practices are similar among all cultures.
Every culture has a set of behaviors, beliefs, and practices that influence a woman during childbearing.
Which response would the prenatal nurse expect for a client who recently learned the fetus has a potentially fatal cardiac defect? Feelings of powerlessness Sense of loss Distancing herself emotionally from the fetus Increased anxiety and fear Requesting termination of the pregnancy
Feelings of powerlessness Sense of loss Distancing herself emotionally from the fetus Increased anxiety and fear
A nurse is caring for a client in her first trimester. The nurse educates the client that events that best facilitate fetal attachment include? Select all that apply. Seeing a positive result on a self-pregnancy test Hearing the fetal heartbeat Telling the family about the pregnancy Seeing the fetus move during an ultrasound examination Feeling the fetus kick or move
Hearing the fetal heartbeat Seeing the fetus move during an ultrasound examination Feeling the fetus kick or move
The prenatal nurse is caring for a primiparous client in her first trimester. The nurse explains to the client that increasing her support network can assist her by? Select all that apply. Increased compliance with health care regimen Decreased incidence of breastfeeding Reduced postpartum depression Improved attachment to infant Dissatisfaction with intimate relationships
Increased compliance with health care regimen Reduced postpartum depression Improved attachment to infant
A nurse is caring for a pregnant client who currently lives with her husband and his three children from a previous marriage. which information is important for the nurse to understand? Nursing care of this client should include all members of her blended family. Although there are other members in this stepparent family, the woman remains the highest priority of the nurse. The new pregnancy is stressful for the other children in the family and they may require extra attention. The events of pregnancy and childbirth are not considered a developmental crisis in the life of a family.
Nursing care of this client should include all members of her blended family.
Which response by a multiparous client indicates to the nurse that acceptance of the pregnancy has been achieved? Select all that apply. Predominately happy feelings about the pregnancy Stress about the financial burden of adding another child to the family Ambivalence and conflict about the pregnancy A dislike of being pregnant but a feeling of love for her unborn child Little physical discomfort or a high tolerance for the discomfort
Predominately happy feelings about the pregnancy A dislike of being pregnant but a feeling of love for her unborn child Little physical discomfort or a high tolerance for the discomfort
A clinic nurse is caring for a client from another culture. which prenatal themes are common across cultures? Select all that apply. Preventing harm to the fetus Breastfeeding Ensuring a safe and easy birth Having a natural birth The avoidance of pain medication
Preventing harm to the fetus Ensuring a safe and easy birth
A clinic nurse is caring for a primiparous client. Which nursing actions are recommended to improve social support during pregnancy? Select all that apply. Provide opportunities for the woman to ask for support. Provide information on mommy groups. Suggest church, health clubs, and electronic resources as sites to meet other women. Provide access to the Centering Pregnancy model of care. Invite family members to attend prenatal and postpartum visits.
Provide opportunities for the woman to ask for support. Provide information on mommy groups. Suggest church, health clubs, and electronic resources as sites to meet other women. Provide access to the Centering Pregnancy model of care. Invite family members to attend prenatal and postpartum visits.
A nurse is caring for a pregnant client who recently moved to the United States from her native country of India. Which is the priority nursing action? Assume the client does not speak English and provide a bedside interpreter to ensure the client understands all medical procedures. Recognize the woman's cultural influences and consider them carefully when planning care. Suggest her Indian coworker care for the client since she is familiar with her beliefs and traditions. Instruct the client how to adopt the practices of the United States
Recognize the woman's cultural influences and consider them carefully when planning care.
A nurse is caring for a pregnant client in her second trimester who recently received news that her fetus has a potentially fatal condition. During her appointment, the nurse notices the woman appears unattached, and seems to have distanced herself from the fetus. Which is the priority action by the nurse? Recognize this as a normal response. Document the findings in the prenatal record. Tell the practitioner the woman is having a hard time coping. Reassure the client that her and her baby will be okay, no matter what happens.
Recognize this as a normal response.
The nurse is caring for a pregnant client experiencing a possible miscarriage. which is the priority nursing action? Intervene to promote psychosocial adaptation to the news of the complication. Allow the woman time to discuss her feelings about the pregnancy complication. Ensure other family members have a correct understanding of the diagnosis. Reestablish and maintain physiologic stability.
Reestablish and maintain physiologic stability.
A nurse from the United States is educating a client from a different country on self-care during pregnancy. At the end of the conversation, the client nods her head and smiles. How would the nurse respond to this behavior? Request the client repeat the information that was taught. Interpret this as an understanding of the information. Smile back and continue with the appointment. Assess the client's emotional health.
Request the client repeat the information that was taught.
A nurse is caring for a client with prenatal depression. which problem should the nurse assess first? Impaired bowel function related to side effects of antidepressant medications Anxiety related to unplanned pregnancy Risk for ineffective coping related to lack of support systems Risk for injury related to depression and suicidal ideation
Risk for injury related to depression and suicidal ideation
A nurse is caring for a pregnant client who recently learned her fetus has a life-threatening complication. The nurse recognizes that the client's response to this finding will depend on which factors? Select all that apply. The condition of the pregnancy The perceived threat to the mother or fetus Whether or not this is her first pregnancy The woman's coping skills The woman's available support
The condition of the pregnancy The perceived threat to the mother or fetus The woman's coping skills The woman's available support
A prenatal nurse is caring for a primiparous client in her first trimester. When caring for this client and her husband, which information is most important for the nurse to understand? During the focusing phase of paternal adaptation, the man reacts to the news of pregnancy with joy, distress, or fear. Men always react to the news of pregnancy with joy, distress, or a combination of emotions. The man may appear to put conscious thought of the pregnancy aside for a period of time. The man will be actively involved in the pregnancy and bonding with the child along with their pregnant partner.
The man may appear to put conscious thought of the pregnancy aside for a period of time.
A pregnant client arrives at the clinic for her first prenatal appointment with her mother. When evaluating the mother-daughter relationship, which components are important for the nurse to assess? Select all that apply. The mother's reaction to her daughter's pregnancy The number of times the mother has been married The mother's willingness to reminisce about her own childbirth How many miscarriages the mother has had The age of the mother when she gave birth to her daughter
The mother's reaction to her daughter's pregnancy The mother's willingness to reminisce about her own childbirth