Chapter 7: Prenatal Care

The client's pregnancy screening test shows that the maternal serum alpha-fetoprotein (MS-AFP) level is high. Which information should the nurse provide the client upon this finding?

"A high level of MS-AFP is associated with neural tube defects. We will schedule you for another type of test to determine if your baby has a neural tube defect." High levels of MS-AFP indicate an increased risk of a neural tube defect and need to be followed up with a diagnostic test. Low levels of MS-AFP are an indicator of increased risk for Down syndrome. The level of MS-AFP is not associated with, or predictive of, preterm labor. A fetal fibronectin test is used to predict risk for preterm labor.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate?

"Do you have a cat in the house?" Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

Which question should the nurse include when conducting a review of systems with a patient during the first prenatal visit?

"Have you had any urinary tract infections?" Urinary tract infections are associated with preterm birth. If the patient has a history of this type of infection, then interventions can be directed to help the patient avoid a urinary tract infection while pregnant. Although a part of the review of systems, asking about peptic ulcers, heart attacks, and neurologic diseases may not have as significant an impact on the developing fetus as having urinary tract infections.

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern?

"I am unsure who the father of the baby is. I will be raising it alone." While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing Rho(D) immune globulin, and having social issues does not place the client at risk for sexually transmitted infections.

The nurse is providing education regarding fetal kicks/movement to a primigravid client at 22 weeks' gestation. Which client statement indicates an understanding of the teaching?

"I will document how long it takes my baby to move 10 times." A healthy fetus moves and kicks regularly. Instruction to the first time mother includes onset of feeling the fetal kicks (16 to 20 weeks' gestation) and understanding typical kick counts (10 kicks per 1 hour). Clients are encouraged to document each kick or change in position on a piece of paper. If 10 movements are not felt within 2 hours, the client should contact her health care provider. It is unrealistic to think the client will record fetal movement and kicks each hour. Kick count should be completed daily, not weekly.

A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.

The nurse manager of a prenatal clinic has implemented interventions to individualize the prenatal care experience. Which patient statement indicates that the nurse's efforts have been successful?

"It was so nice to not have to wait long in the waiting room." Strategies to individualize prenatal care include trying to schedule appointments so there won't be a long wait time, providing privacy for weight and blood pressure assessments, educating on care options and encouraging participating in decisions about care, and providing materials on pregnancy in the waiting room.

The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed?

"Pain with urination is expected during pregnancy." Pain on urination is a symptom of a urinary infection, potentially serious because these are associated with preterm birth. This statement indicates that additional patient teaching is needed. The patient should call the doctor with any vaginal bleeding. A sudden rush of fluid indicates the membranes have ruptured. Once a day vomiting is not uncommon during the first trimester of pregnancy.

A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction?

"Taking gentle enemas no more frequently than once a week is acceptable." Constipation is a common source of concern for many women in pregnancy. It results from the slowing of intestinal peristalsis and also as a side effect of iron administration. Steps such as increasing fluid intake, increasing dietary fiber, and exercising are beneficial in reducing constipation. Weekly enemas during the pregnancy are not advisable. Enemas can be habit forming and do not correct the causes of the constipation being experienced.

A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate?

"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.

At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse?

"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." A glucose tolerance test involves a glucose load and a blood glucose level 1 hour later. It is a screening test used to determine if the client needs a full 3-hour oral glucose tolerance test. A 1-hour glucose tolerance test is not diagnostic of insulin resistance nor gestational diabetes. If the screening test is elevated the client is scheduled for the diagnostic test at approximately 24 to 26 weeks' gestation. If a client is eventually diagnosed with gestational diabetes, the initial treatment is diet therapy, not insulin.

A patient at 6 weeks' gestation asks if she can listen to the fetal heart sounds. The nurse informs the patient that fetal heart sounds cannot be heard with a Doppler until when?

10 to 12 weeks Explanation: Fetal heart sounds can be heard through a Doppler at 10 to 12 weeks and through a regular stethoscope at 18 to 20 weeks.

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?

20 cm Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.

A primigravida client has presented for her first prenatal visit and is concerned about the potential weight gain and the struggle to lose the weight after the baby's birth. How much weight should the nurse recommend this client with a normal BMI gain during her pregnancy to ensure a healthy fetus?

30 to 35 lbs The nurse should convey that weight gain is healthy and that the client with a normal BMI should gain 30 to 35 lb (13.6 to 15.8 kg) to ensure a healthy fetus.

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

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

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

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

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

4, 1, 1, 1, 1 The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

The nurse is caring for a client in her second trimester who requires follow-up genetic testing after a common screening indicated a potential abnormality. What is the nurse's main role at this time?

Allowing the client to vent feelings It is a difficult time for the client and family. The nurse's main role is to support the client and family and allow the client to vent any feelings. The nurse will also assist in answering any questions but much of this information comes from health care provider. Next, the nurse will facilitate the testing process and witness the signature as the testing requires informed consent.

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.

A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy?

Amniocentesis. Amniocentesis to screen for congenital anomalies can be done starting at 14 weeks' gestation. This procedure carries risks of spontaneous abortion, infection, and placental abruption. Cardiocentesis is used less commonly to determine blood disorders. Chorionic villi sampling is performed at 8 to 12 weeks' gestation. Nuchal translucency testing is done between 11 and 13 weeks' gestation.

Why is the first prenatal visit usually the longest prenatal visit?

Baseline data is collected. The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

A client at 10 weeks' gestation is complaining of ptyalism over the past 2 weeks. What intervention would the nurse recommend to this client? Select all that apply.

Chew gum. Suck on hard candies. Ptyalism or excess salivation may be relieved by chewing gum or sucking on hard candies. Many of the interventions used to relieve nausea and vomiting may also work for ptyalism.

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply.

Complete moderate exercise daily. Wear compression stockings. Suggestions of exercising and wearing compression stockings are most helpful to the client with lower extremity edema and varicose veins. It is also helpful to have frequent rest periods with the legs elevated above the heart. Fluid intake is not to be limited. Avoiding sudden position changes helps prevent round ligament pain.

A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?

Conduct an interview in a private room to obtain her health history. Health interviewing is always conducted best in a quiet, private setting before examination procedures begin.

As part of the assessment of a client's health history during the first prenatal visit, the nurse is having the client complete a 24-hour recall to establish what and how much the woman is eating. In which section of the health history should the nurse record this information?

Day history/social profile The day history/social profile contains information about a woman's current nutrition, elimination, sleep, recreation, and interpersonal interactions. This information can be elicited best by asking a woman to describe what her typical day is like. The chief concern is the reason the woman has come to the health care setting—in this instance, the fact she is or thinks she is pregnant. Among other things, this section of the health history should include the date of her last menstrual period, whether it was normal for her and whether she has used a home test pregnancy kit. Demographic data usually obtained include name, age, address, telephone number, e-mail address, religion, ethnicity, type and place of employment, and health insurance information. Questions about a woman's past medical history are important because a past condition can become active during or immediately following pregnancy.

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:

December 30 Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

The nurse is preparing a care plan for a primigravida client and her partner who are excited about her pregnancy and ask lots of questions on various subjects. Which nursing diagnosis should the nurse prioritize for this client and her partner in this care plan?

Deficient knowledge The most appropriate nursing diagnosis in this case would be "deficient knowledge." This can entail various topics to include nutrition, exercise, testing, and even the sex of the baby. The other choices are also potential nursing diagnoses but would involve other types of activities. The couple is not displaying fear but are seeking information that will help them be successful with their pregnancy.

While conducting the first prenatal health history visit, the nurse learns that a pregnant patient is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time?

Deficient knowledge regarding exposure to teratogens during pregnancy The patient is taking herbal remedies and over-the-counter medications, many of which can be teratogenic to the developing fetus. This is the most appropriate nursing diagnosis for the nurse to select for this assessment finding. There is no enough information to determine if the fetus is at risk because of the patient's lifestyle choices. The patient has not asked for specific information so health-seeking behavior diagnoses would not be appropriate for the patient at this time.

The health care provider is concerned about a client's fetus having appropriate blood flow through the fetal vessels. Which diagnostic test does the nurse anticipate to confirm a diagnosis?

Doppler study The Doppler flow study is best for identification of blood flow. It places a transducer on the client's abdomen and allows the sonographer to assess blood flow through fetal vessels and in the fetal aorta, brain and heart. A transabdominal ultrasound is commonly used to determine gestational age, observe the fetus and diagnose complications of pregnancy. Amniocentesis is commonly used to identify chromosomal or genetic abnormalities. The maternal serum alpha-fetoprotein screening is used to determine neural tube defects.

A client at 10 weeks' gestation is reporting nausea and vomiting throughout the day. What interventions would the nurse recommend to this client? Select all that apply.

Eat small frequent meals. Avoid fried foods. Eat saltine crackers before getting out of bed. Interventions such as eating frequent small meals, avoiding fried and odorous foods, being exposed to fresh lemon smell, peppermint, ginger, acupressure, and B6 may be helpful. The woman needs to avoid an over-full stomach and taking liquids with meals. Over the counter antiemetics are not safe in early pregnancy.

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

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

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?

Helps the lungs remain expanded after the initiation of breathing Surfactant keeps the alveolar surfaces from sticking together, allowing the lungs to expand and making it easier for the neonate to breathe. Surfactant does not remove mucus or mature the upper airway. It does not effect the breathing pattern, just the effort needed to expand the alveoli.

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

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

A nurse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply.

Individualized assessment Counseling Teaching Nurses contribute to the success of prenatal care through individualized assessment, counseling, and educating. Assistance with social coordination and authoritarian decision making are not associated with successful prenatal care.

A gravid client is talking with the nurse about the excessive nausea and vomiting she has been experiencing throughout the day. She asks why this is happening to her and what she can do to reduce the nausea. What information should be included in the nurse's response? Select all that apply.

Ingesting small frequent meals in pregnancy is helpful to manage nausea. Eating a high carbohydrate snack before getting out of bed may be helpful. Nausea and vomiting in pregnancy is associated with elevated human chorionic gonadotropin (hCG) levels. Progesterone and estrogen levels are elevated in pregnancy but the normal levels associated with pregnancy are not linked to an increased occurrence of nausea and vomiting. Unusually elevated hormone levels, however, are associated with increased incidents of nausea and vomiting. Eating small frequent meals instead of large bulky meals can assist with the nausea. Ingesting a high carbohydrate snack such as crackers before arising from bed in the morning is also associated with reduced levels of nausea.

When explaining what will occur during the first prenatal visit physical examination, a pregnant client asks why a Papanicolaou test is being done at this time. What should the nurse respond to the client?

It detects cancer cells of the cervix, vulva, or vagina. A Papanicolaou test is taken from the endocervix at a first prenatal visit to be certain a precancerous or cancerous condition of the uterine cervix, vulva, or vagina is not present. A Papanicolaou test is not used to date a pregnancy, detect uterine cancer, or predict if cervical cancer will occur.

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

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

A client's last menstrual period was April 11. Using the Naegele rule, her estimated date of delivery (EDD) would be:

January 18. To use the Naegele rule, subtract 3 months and then add 7 days to the first day of the client's LMP (April 11): April minus 3 months is January, plus 7 days is 18. Thus, her estimated date of delivery (EDD) would be January 18 of the next year.

The nurse is caring for a client having chorionic villus sampling using the transcervical approach. When preparing the client for the procedure, in which position is the client placed?

Lithotomy position The lithotomy position with the legs in stirrups is the best position to access the cervical region. The other options make it difficult, if not impossible, to access.

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

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

A client at 32 weeks' gestation telephones the health care provider's office asking if omeprazole 20 mg daily is safe to take as she is experiencing heartburn. When reviewing the over-the-counter medication, the nurse notes a pregnancy category C listed. Which would be the nurse's first action?

Offer to speak with the health care provider and then return her call. Heartburn is a common occurrence in pregnancy; however, the nurse does not authorize medications without speaking with the health care provider first. Omeprazole, an over-the-counter medication, is pregnancy category C (indicating that not enough human studies have been conducted). It would be up to the health care provider to determine acceptable usage.

The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria does the nurse look for on the tracing to determine that the NST is reactive?

Presence of 2 accelerations in 20 minutes An NST is an assessment of fetal well-being. The criteria for a reactive NST is the presence of two accelerations in a 20-minute window. The presence of decelerations or contractions would require further evaluation of fetal status.

The nurse is conducting an assessment of a pregnant client at a routine second trimester prenatal visit. Which lower extremity assessment should the nurse prioritize?

Presence of varicosities During pregnancy, women are prone to develop varicosities because of uterine pressure on lower-extremity veins. Evaluating the diameter of the calf would be important if a deep vein thrombosis was suspected. Capillary refill of the toenails would be a routine evaluation. Lateral movement of the kneecap would not be a priority.

The nurse is assessing a woman who is pregnant for the first time. Which of the following terms applies to this client?

Primigravida Gravida refers to a woman who is or has been pregnant. Primigravida refers to a woman who is pregnant for the first time, which is the case in this scenario. Multigravida refers to a woman who has been pregnant previously. Nulligravida refers to a woman who has never been and is not currently pregnant. Para refers to the number of pregnancies that have reached viability, regardless of whether the infants were born alive. Primipara refers to a woman who has given birth to one child past age of viability.

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one?

Provide knowledge and skills to actively participate in birth and parenting. The primary focus of perinatal education is to provide information and support to clients and their families to foster a more active role in the upcoming birth. It also includes preparation for breastfeeding, infant care, transition to new parenting roles, relationships skills, family health promotion, and sexuality. Some methods of birth education focus on pain-free birth. Information provided in birth education classes helps to minimize anxiety and provide the couple with control over the situation, but elimination of anxiety or total control is unrealistic.

Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman?

Rubella Rubella (German measles) is an infection caused by the rubella virus. The virus causes a rash and mild symptoms in children but can be teratogenic to a fetus. A rubella titer determines if the mother is immune to the virus. If the mother is not immune, the mother will receive a rubella immunization immediately after delivery. Diphtheria and polio are infant vaccines but not as teratogenic to the fetus. Rotavirus is a gastrointestinal virus typically mild in adults.

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 10. Which nursing action is best?

Schedule a health care provider appointment for one week. A biophysical profile of 10 is a good score indicating fetal well-being. The nurse would schedule this client for her weekly health care provider appointment. There is no need to immediately notify the health care provider, have the client report to the hospital nor prepare the records for a cesarean birth indicating the fetus needs to be born.

Which of the following would you advise a woman about breast self-examination during pregnancy?

She should choose a date each month to do this. Nonpregnant women use their menstrual period as a reminder to do a self-exam. Without this reminder, pregnant women need to use another system, such as a certain day each month.

A 20-year-old woman you see in a prenatal clinic has an accessory nipple. Which of the following teaching points would be most important to make with her?

Such growths deepen in color during pregnancy. Pigment changes can be expected during pregnancy. Alerting women to this can decrease anxiety.

The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

While triaging messages from the answering machine from clients with the following symptoms, which client would obtain the first visit of the day?

The client at 11 weeks' gestation experiencing abdominal cramping The nurse is correct to have the client with the most acute symptom to have the earliest appointment. The client with the most acute symptom is the client in the first trimester experiencing abdominal cramping. The other clients are experiencing common discomforts of pregnancy.

The nurse is caring for a client with a G=5, T=0, P=3, A=1, L=3 obstetric history. The nurse is most correct to state which interpretation?

The client has had difficulty reaching full term. When interpreting the obstetric history, it is noted that the client has had three preterm pregnancies and that her children are living. The client also had one abortion, whether elective or a miscarriage. Thus, the interpretation most accurate is that the client has had difficulty reaching a full-term pregnancy. The client has had pregnancy complications. There is no evidence that the client has had difficulty becoming pregnant nor had multiple abortions.

A nurse in an obstetric clinic is preparing the staff for a prenatal appointment with an incarcerated pregnant woman. What does the nurse explain is the main difference when an incarcerated client comes to the clinic?

There will be correction officers with the woman throughout her appointment. Care considerations and provision of care are the same as for the nonincarcerated population. During a visit with an off-site provider, the corrections officer may be asked to leave the room during the course of the visit to maintain client privacy. The presence of the officer may be required, however, in situations in which the lack of presence may pose a danger to the healthcare staff or the examination space available offers a flight risk. In some cases the officer may be required to maintain direct visual contact of the inmate at all times. Correctional facility medical staff, including nurses and other healthcare providers, often do not provide any prenatal care or provide only limited prenatal care, with ultrasounds and management of high-risk pregnancies occurring off-site. Typically the woman will not be handcuffed or shackled unless she is a danger to others.

The nurse receives a call from a concerned client, who is 39 weeks' gestation, indicating the woman has "blood-tinged mucus seeping from the vagina." What does the nurse understand about this?

This is known as "bloody show" and is a normal finding at this time. In preparation for birth, the mucous plug that filled the cervical canal is expelled. The mucous is blood tinged. The "bloody show" is normal at this time. This "bloody show" is not caused by increased activity. The nurse would not recommend left side-lying position unless the woman was experiencing preterm cramping. Braxton Hicks contractions are known as false labor.

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?

Ultrasound equipment First, the health care provider identifies a pocket of amniotic fluid using an ultrasound machine. The ultrasound then guides the 20- or 22-gauge spinal needle into the fluid placement. A scalpel is not used in the procedure. A urine culture is not obtained prior to the procedure.

The nursing instructor is explaining the nursing care that is given to a client during her pregnancy. The instructor determines the session is successful when the students correctly choose which method will be used to evaluate the effectiveness of the nursing care they will provide?

Verify that desired outcomes for identified goals have been met. Evaluating the effectiveness of nursing care given during pregnancy is to look at the nursing diagnosis for the specific client, identify the goals and their desired outcomes for each diagnosis, and see if the desired outcomes are achieved. This may involve using a preprinted survey and interviewing the client. The nursing diagnoses should be established at the beginning to help guide the care for each individual client.

The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care?

Wash the nipples with clean water only. She should use only clean water to wash the nipples. The use of any soap will dry the nipples and can lead to cracking.

During pregnancy, the cardinal rule concerning medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?

asthma Treatment (including medications) for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression.

A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?

at the level of the umbilicus In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed?

fundal height measurement On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the woman's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.

A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information?

gravida 4, para 2 Gravida refers to the total number of pregnancies (including current), para to the number of births. The abortion would be noted as an "A" if using the full "GTPAL."

The nurse is preparing the client for the routine laboratory tests that will be obtained at the first prenatal visit. Which test will the nurse prioritize at this visit?

hepatitis screen The woman will undergo tests for hepatitis B, HIV, syphilis, gonorrhea, and chlamydia. Each of these infections can cause serious fetal problems unless they are treated. Rubella is more concerning than rubeola and a titer may be completed to assess the woman's immunity to rubella. Other blood tests will include a complete blood count to evaluate anemia, blood type and antibody screen, and possibly thyroid screen to evaluate for hypothyroidism.

A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment?

history of diabetes for 4 years A diagnosis of diabetes in a pregnant client increases risk for both the client and the infant during pregnancy and requires close monitoring and follow-up. This client's age, exercise history, and history of occasional OTC pain reliever use do not increase pregnancy risk.

An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?

intimate partner violence Pregnant women, especially adolescents, are at increased risk for intimate partner violence. The nurse needs to ask enough questions to be certain that the woman is not experiencing physical, sexual, or emotional intimate partnership violence.

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?

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

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care?

once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

The nurse is assessing the latest laboratory results of a pregnant client who is at 17 weeks' gestation. The nurse should prepare to teach the client about which possible defects after noting the maternal serum alpha-fetoprotein level is above normal?

open spinal defects Elevated MSAFP levels are associated with open neural tube defects, underestimation of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight, oligohydramnios, maternal age, diabetes, and decreased maternal weight. Lower-than-expected MSAFP levels are seen when fetal gestational age is overestimated or in cases of fetal death, hydatidiform mole, increased maternal weight, maternal type 1 diabetes, and fetal trisomy 21 (Down syndrome) or 18. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. Maternal hypertension would be noted via serial blood pressure monitoring.

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. This occurs about 4 or 5 times during the testing period. The nurse interprets this as:

reactive pattern. A reactive NST includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within the 20-minute recording period. If the test does not meet these criteria after 40 minutes, it is considered nonreactive. A nonreactive NST is characterized by the absence of two fetal heart rate accelerations using the 15-by-15 criterion in a 20-minute time frame. An increase in the fetal heart rate does not indicate variable decelerations. Fetal tachycardia would be noted as a heart rate greater than 160 bpm.

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

the first day of the last menstrual period. Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date nor last day of the menstrual period is needed.