Exam 1 OB

A client who became pregnant at a weight of 60 kg and a BMI of 16 has gained 4 kg at the end of the 5th gestational month. How many more pounds of weight should the nurse counsel this client to gain to achieve the least amount of weight that an underweight person should gain while pregnant?

19.2 lb (For a client with a BMI less than 18.5, the weight gain for the total pregnancy should be between 28 and 40 lb. The client has gained 4 kg, or 8.8 lb. To achieve the minimal amount of weight that the client should gain during the entire pregnancy, subtract the amount of weight gained from the minimal amount, or 28 lb - 8.8 lb = 19.2 lb.)

A newly pregnant client weighs 75.0 kg and has a body mass index of 28.5. What is the maximum amount of weight in pounds that this client should weigh during the pregnancy?

190 lb (Explanation: For a client with a BMI between 25.0 and 29.9, the weight gain for the total pregnancy should be between 15 and 25 lb. This client's weight is 75 kg. To determine the maximum amount of weight to gain, first determine the client's weight in pounds by multiplying the weight in kilograms by 2.2, or 75.0 × 2.2 = 165 lb. Then add the maximum amount of weight of 25 lb to this total, or 165 + 25 = 190 lb.)

How should the nurse interpret a pregnant client's lecithin/sphingomyelin (L/S) ratio finding of 2:1 on amniotic fluid? a. Fetal lungs are mature. b. Fetal lungs are still immature. c. The fetus has a congenital anomaly. d. The fetus is small for gestational age.

a (A 2:1 L/S ratio indicates that the risk of respiratory distress syndrome (RDS) is very low and that the fetus's lungs are mature. Early in pregnancy, the sphingomyelin concentration in amniotic fluid is greater than the concentration of lecithin, and so the L/S ratio is low if the fetus's lungs are immature, which is not the case in this instance. The L/S ratio is not a measurement for congenital anomalies. The L/S ratio is not a measurement for size of the fetus.)

A 26-year-old multigravida who is 28 weeks pregnant and follows a program of regular exercise develops gestational diabetes. What instructions should be included in a teaching plan for this client? a. "Carry hard candy (or other simple sugar) when exercising." b. "If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate." c. "Exercise either just before meals or wait until 2 hours after a meal." d. "If your blood sugar is more than 120 mg/dL, drink a glass of whole milk."

a (A client should be encouraged to continue any exercise programs in which she already is involved. She should keep hard candy (simple sugar) with her at all times, just in case the exercise induces hypoglycemia. A finger-stick result of 120 mg/dL is considered to be normal. It is best to exercise just after the meal in order to utilize the glucose. Such clients need no additional carbohydrate or protein intake.)

A pregnant client's fundal height is 26 cm at 32 weeks' gestation. Why would the healthcare provider schedule this client for sonograms every 2 weeks? a. Evaluate fetal growth b. Determine fetal presentation c. Assess for congenital anomalies d. Rule out a suspected hydatidiform mole

a (A person who is at 32 weeks' gestation should measure 32 cm of fundal height. When a discrepancy between fundal height and measurement exists, the purpose of serial ultrasounds is to monitor fetal growth. Fetal presentation would require only one ultrasound. Assessment of anomalies would require only one ultrasound. Ruling out a hydatidiform mole would require only one ultrasound.)

A 7-year-old client says, "Grandpa, mommy, daddy, and my brother live at my house." In what type of family should the nurse identify that this child lives? a. Extended b. Binuclear c. Traditional d. Gay or lesbian

a (An extended family contains a parent or a couple who share the house with their children and another adult relative. A binuclear family includes the divorced parents, who have joint custody of their biologic children, who alternate spending varying amounts of time in the home of each parent. The traditional nuclear family consists of an employed provider parent, a homemaking parent, and the biologic children of this union. A gay or lesbian family is composed of two same-sex domestic partners; they might or might not have children.)

The nurse is supervising care in the emergency department. Which situation requires immediate intervention? a. Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20. b. Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports the presence of fetal movement. c. Spotting of pinkish brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour. d. Moderate vaginal bleeding at 36 weeks' gestation; client has an IV of lactated Ringer solution running at 125 mL/hour.

a (Bleeding in the third trimester is usually associated with placenta previa or placental abruption. Blood loss can be heavy and rapid. This client has a low blood pressure with an increased pulse rate, which indicates hypovolemic shock, which can be fatal to the mother and therefore the baby. Both lives are at risk in this situation. Since there is no information given that the client has an IV started, this client is the least stable, and therefore the highest priority. Occasional spotting can occur. The presence of normal vital signs and usual fetal movements reduces this client's risk of needing immediate intervention. Bleeding in the first trimester can be indicative of the beginning of spontaneous abortion or of an ectopic pregnancy. An ultrasound will diagnose which situation is occurring and will determine care. Because this client is very early in the pregnancy and only experiencing spotting, it is not appropriate to have an IV at this time. Bleeding in the third trimester is usually associated with placenta previa or placental abruption. Blood loss can be heavy and rapid, so having an IV stabilizes the client's vascular volume.)

The nurse is leading a session on nutrition for postpartum clients. Which statement indicates that teaching has been effective? a. "Breastfeeding requires that I eat lots of protein daily." b. "Because I am breastfeeding, I need a low calcium intake." c. "Since I am bottlefeeding, I don't have to eat vegetables." d. "Bottlefeeding moms like me require a high sodium intake."

a (Breastfeeding clients should consume 65 g of protein daily during the first 6 months of breastfeeding and 62 g daily during the second 6 months. Protein is a major ingredient in breast milk. Breastfeeding requires an increase of 1000 mg per day of calcium—the same amount of calcium that is recommended during pregnancy. Although vitamin intake is not directly related to bottlefeeding, good nutritional habits are important to form while bottlefeeding, because in the future, the baby will be eating what the mother eats. Sodium intake is not increased during bottlefeeding.)

The nurse who is counseling a group of middle school girls on pregnancy avoidance should include which statement? a. "Although condom use is growing, there is still an increasing rate of STIs among teens." b. "It has become far less acceptable to give birth during your teenage years than it used to be." c. "You have learned enough from your friends and families to understand how pregnancy occurs." d. "Although sexuality is common in the media, your peer pressure to have sex is not an important factor."

a (Condom use is increasing, but the rate of sexually transmitted infections (STIs), including HIV, is also rising. Research indicates that young people 15 to 24 years of age make up 25% of the sexually experienced population in the United States. However, they account for nearly half of the new cases of STIs. Society has become more accepting of teen pregnancy, and there are fewer stigmas attached to being a young mother. Formal education on the physiology of the body and conception will decrease the myths and misunderstandings that abound among teens and undereducated adults. Images of sexuality are common in American society: in music lyrics and videos, in advertising, in television shows and movies. Peer pressure to have sex is also common, and is a strong influence on when a teen becomes sexually active.)

The nurse instructs on the importance of niacin during a preconception counseling class. Which food item selected by a participant indicates that teaching about the sources of niacin has been effective? a. Fish b. Milk c. Apples d. Broccoli

a (Dietary sources of niacin include meats, fish, and enriched grains. Milk will provide sources of other vitamins; however, it does not contain significant niacin. Apples will provide sources of other vitamins; however, they do not contain significant niacin. Broccoli will provide sources of other vitamins; however, it does not contain significant niacin.)

The nurse is reviewing the assessment findings of a client who is at 35 weeks' gestation. Which data suggest the need for further investigation? a. Glycosuria b. Funic souffle c. Pseudoanemia d. Melasma gravidarum

a (Glycosuria (glucose in the urine) during pregnancy may be normal or may indicate gestational diabetes, so it always warrants further testing.Funic souffle is a normal assessment finding associated with the pulsing of blood through the umbilical cord.Physiologic anemia of pregnancy or pseudoanemia is common during pregnancy and is an expected finding. Facial chloasma or melasma gravidarum (also known as the "mask of pregnancy") is a harmless darkening of the skin over the cheeks, nose, and forehead that sometimes accompanies pregnancy.)

During the first antepartal visit, a client who is at 10 weeks' gestation learns of being HIV positive. Which client statement indicates an understanding of the plan of care both during the pregnancy and postpartally? a. "I should not breastfeed my baby." b. "When my baby is 2 months old, he or she will be tested for HIV." c. "If I have a cesarean section, there is an increased risk that my HIV will be passed to my baby." d. "I am supposed to take highly active antiretroviral therapy (HAART), but only during the first trimester."

a (HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth. Following birth, HIV infection in infants should be diagnosed using HIV virologic assays as soon as possible, with initiation of infant antiretroviral prophylaxis immediately if the test is positive. Cesarean section reduces the transmission of HIV from mother to infant. Longer duration therapy is preferable to shorter duration approaches, and it is best to start prophylaxis after the first trimester and no later than 28 weeks' gestation in women who do not require immediate therapy for their own health.)

Which phone call should the prenatal clinic nurse return first? a. Primipara at 32 weeks, reports headache and blurred vision b. Primipara at 16 weeks, reports increased urinary frequency c. Multipara at 18 weeks, reports no fetal movement this pregnancy d. Multipara at 40 weeks, reports sudden gush of fluid and contractions

a (Headache and blurred vision are signs of preeclampsia, which is potentially life threatening for both mother and fetus. This client has top priority. Increased urinary frequency is common during pregnancy as the increased size of the uterus puts pressure on the urinary bladder. Urinary frequency is expected. If the client were reporting dysuria or hematuria, a urinary tract infection (UTI) would be suspected, but this client is only reporting increased urinary frequency. This client is a lower priority. Fetal movement should be felt by 19 to 20 weeks. Multiparas sometimes feel fetal movement prior to 19 weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This client is a lower priority. A term client who is experiencing contractions and a sudden gush of fluid is in labor. Although laboring clients should be in contact with their healthcare provider for advice on when to go to the hospital, labor at term is an expected finding. This client is a lower priority.)

The nurse is presenting an in-service to nursing staff regarding the provision of culturally competent client care. Which statement should the nurse include in the presentation? a. "Developed countries are becoming increasingly more ethnically diverse." b. "The rituals and customs of a group reflect the values of the dominant culture." c. "Identification of cultural values is a task that is unrelated to providing culturally sensitive care." d. "Many immigrants to a new country will adopt the beliefs and practices of the dominant culture."

a (In many developed countries such as, for example, the United States, Canada, England, and Germany, populations are becoming more and more ethnically diverse as the number of immigrants continues to grow. The rituals and customs of a group are a reflection of the group's values. The identification of cultural values is useful in planning and providing culturally sensitive care. It is not realistic or appropriate to assume that people of another culture will automatically abandon their ways and adopt the practices of the dominant culture.)

The nurse reviews nutritional requirements with a breastfeeding mother who is concerned that her milk production has decreased. Which statement indicates that further teaching is required? a. "I have started cutting back on my protein intake." b. "At least 3 times a day, I drink a glass of milk." c. "I am drinking a minimum of 8 to 10 glasses of liquid a day." d. "I try to take a nap in the morning and afternoon when the baby is sleeping."

a (It is especially important for the breastfeeding mother to consume sufficient calories because inadequate caloric intake can reduce milk volume. The decreased intake of protein represents a decrease in calories, which will decrease milk production. The breastfeeding mother must increase her protein and calcium intake. The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day. It has also been found that adequate rest is necessary for the body to maintain its production of milk.)

The partner of a pregnant client at 16 weeks' gestation accompanies her to the clinic. The partner tells you that the baby just does not seem real to him, and he is having a hard time relating to his partner's fatigue and food aversions. Which statement would be best for the nurse to make? a. "Many men feel this way. Feeling the baby move will help make it real." b. "My husband had no problem with this. What was your childhood like?" c. "You might need professional psychologic counseling. Ask your physician." d. "If you would concentrate harder, you would be aware of the reality of this pregnancy."

a (Kicking and ultrasound visualization are concrete evidence of the baby's existence and often are turning points in acceptance for partners. The ambivalence and disbelief occur across all socioeconomic groups, in both partners who were fathered well and those who grew up without a father. This reaction is not indicative of psychologic pathology. Ambivalence is common among partners, especially prior to either seeing the baby on ultrasound or feeling the baby kick and move.)

Which approach to planning educational activities is best suited to a group of pregnant adolescents? a. Primarily using visual-based presentations during teaching b. Combining teaching for adolescent mothers of all ages as one group c. Respecting confidentiality and building trust by avoiding the topics of drug and alcohol abuse d. Avoiding the inclusion of handouts with bulleted items and white space as part of the teaching

a (Many teens prefer teaching aids that are visual and that they can handle, such as realistic fetal models. Teaching adolescents in groups according to their ages may be more effective for learning because younger adolescent mothers' parenting skills and emotional needs may differ from those of older adolescent mothers. The nurse should review the risks associated with the use of tobacco, caffeine, drugs, and alcohol, as well as discussing the fetal effects of these substances. Some pregnant teens have low reading levels and tend to prefer handouts and posters that have visual interest, short sentences, bulleted items, and white space.)

The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings? a. Have the healthcare provider see the client today. b. Instruct the client to avoid direct sunlight. c. Document the findings on the prenatal chart. d. Analyze previous thyroid hormone laboratory results.

a (Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and nail bed pallor can indicate either hypoxia or anemia. These abnormalities must be reported to the healthcare provider immediately. Spider nevi are common in pregnancy due to the increased vascular volume and high estrogen levels. Nasal passages can be inflamed during pregnancy from edema, caused by increased estrogen levels. These abnormalities must be reported to the healthcare provider immediately. The thyroid gland increases in size during pregnancy due to hyperplasia.)

The community nurse is caring for a client at 32 weeks' gestation diagnosed with preeclampsia. Which statement indicates that additional information is needed about the health problem? a. "My urine may become darker and smaller in amount each day." b. "Lying on my left side as much as possible is good for the baby." c. "I should call the doctor if I develop a headache or blurred vision." d. "Pain in the top of my abdomen is a sign my condition is worsening."

a (Oliguria is a complication of preeclampsia caused by renal involvement and is a sign that the condition is worsening. Oliguria should be reported to the healthcare provider. Left lateral position maximizes uterine and renal blood flow and therefore is the optimal position for a client with preeclampsia. Headache and blurred vision or other visual disturbances are an indication of worsening preeclampsia and should be reported to the healthcare provider. Epigastric pain is an indication of liver enlargement, a symptom of worsening preeclampsia, and should be reported to the healthcare provider.)

While developing a conference for adolescents, the nurse prepares a handout describing socioeconomic and cultural factors that contribute to adolescent pregnancy. Which information should the nurse include in the handout? a. Poverty is a major risk factor for teen pregnancy. b. All cultures share an aversion to early pregnancy. c. A child born to a teenage mother is at a lower risk for teen pregnancy. d. The younger the teen when she first gets pregnant, the less likely she is to have another pregnancy in her teens.

a (Poverty is a major risk factor for teen pregnancy. Adolescents who do not have access to middle-class opportunities tend to maintain their pregnancies because they see pregnancy as their only option for adult status. Teens who are on a low economic trajectory are more likely to become pregnant because of the lack of economic opportunity and the social marginalization that comes with poverty. Early pregnancy is desirable in some cultures, such as where Islam is the predominant religion, where large families are desired, where social change is slow in coming, and where most childbearing occurs within marriage. Daughters and sisters of a woman who had a baby in her early teens tend to have intercourse earlier and are at higher risk for teen pregnancy themselves. The younger the teen when she first gets pregnant, the more likely she is to have another pregnancy in her teens.)

The mother of a client who is 14 weeks pregnant is uncertain about how to be a good grandmother to this baby due to working full time and being so busy. How should the nurse respond in this situation? a. "How do you envision your role as grandmother?" b. "Don't worry. You'll be a wonderful grandmother. It will all work out fine." c. "As long as there is another grandmother available, you do not have to worry." d. "Grandmothers are supposed to be available. You should retire from your job."

a (Supportive, nonjudgmental exploration of the client's concerns is one component of therapeutic communication and is appropriate. Casual and/or false reassurance is not appropriate. Effective therapeutic communication requires supportive, nonjudgmental exploration of the client's concerns. Minimizing a client's concern is not appropriate. Effective therapeutic communication requires supportive, nonjudgmental exploration of the client's concerns. Assignment of guilt is not appropriate. Effective therapeutic communication requires supportive, nonjudgmental exploration of the client's concerns)

The nurse is assisting an expectant couple in developing a birth plan. Which instructions should the nurse include when teaching about this plan? a. It is a communication tool between the client and the healthcare provider. b. It is a legally binding contract between the client and the healthcare provider. c. It allows the client to make choices about the birth process; however, these choices cannot be altered. d. It includes only client choices and does not take into account standard choices of the healthcare provider.

a (The birth plan is used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals at the birth setting. It is not a legal document. The written plan identifies options that are available; thus, it can be altered. The birth plan is used as a tool for communication among the expectant parents, the healthcare provider, and the healthcare professionals at the birth setting.)

During an assessment, the nurse notices that an African American baby has a darker, slightly bluish patch about 5 by 7 cm on the buttocks and lower back. What should the nurse do? a. Chart the presence of a Mongolian spot. b. Ask the mother about the cause of the bruise. c. Confer with the physician about the possibility of a bleeding tendency. d. Call the Department of Social Services (DSS) to report this sign of abuse.

a (The nurse will chart the presence of a Mongolian spot, such as is observed in races with dark skin tones. Asking the mother about the cause of the bruise reveals cultural ignorance in a less damaging manner than does calling DSS. If choosing to confer with the physician, the nurse will reveal ignorance in culturally competent assessments. The nurse who calls the DSS to report this patch as a sign of abuse will reveal ignorance in culturally competent assessments and possibly provoke harassment of the family.)

During an interview the nurse asks the partner of a woman in the second trimester of pregnancy what changes they have noticed during the pregnancy. Which answer would indicate a typical response to pregnancy? a. "She daydreams about what kind of parent she is going to be." b. "I have not noticed anything. I just found out she is pregnant." c. "She has been having dreams at night about misplacing the baby." d. "She has been more tense and anxious than usual, and she is not sleeping well."

a (The second trimester usually brings increased introspection and consideration of how she will parent. In the first trimester, pregnant women usually tell their partners of the pregnancy, explore their relationship with their mother, and think about their own role as a mother. The needs of the newborn typically are not considered until the third trimester, at which time dreams of misplacing the baby or being unable to get to the baby also may be common. During the third trimester, the woman typically experiences more anxiety and tension, as well as increased discomfort and insomnia.)

A client at 30 weeks' gestation is tearful at the time of her follow-up visit. She tells the prenatal clinic nurse that she is excited to finally become a mother and that she has been thinking about what kind of parent she will be. However, she is upset because her mother has told her that she does not want to be a grandmother because she does not feel old enough. Meanwhile, the client's husband has said that the pregnancy does not feel real to him yet and that he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family? a. Family members are adjusting to the role change at their own pace. b. Her mother is rejecting the role of grandparent and will not help out. c. Her husband will not attach with this child and will not be a good father. d. The client is not progressing through the developmental tasks of pregnancy.

a (This is a true statement. When the other family members are at different stages of adjustment to the pregnancy, conflict can ensue. Adaptation to the role of grandparent is another life task that takes time. Younger grandparents often have busy and full lives and view grandparenthood as a time for elderly people who are retired and slowed down. The family will form a view of grandparenthood within this family, in a way that works for them. The husband's statement is quite common. Partners often feel that a pregnancy is not real to them because they are not experiencing any of the physical changes associated with pregnancy. This is a false statement. The client is at the stage of seeking acceptance of this child by others, which first will be her partner and other family members.)

The pregnant client has completed the prenatal questionnaire and asks the nurse why this form had to be filled out. Which response is the most appropriate? a. "We occasionally identify a health problem that puts the current pregnancy at higher risk." b. "This form is designed to predict who will develop problems with their pregnancy or delivery." c. "The doctor wants all of the pregnant clients to fill out the form so that our records are complete." d. "Some people have things that have happened in the past that could impact their current pregnancy."

a (This is the reason for risk assessment during pregnancy, whether it is a client-completed questionnaire or a nurse assessment form. The form will identify those clients who have risk factors based on their medical history; prediction implies seeing into the future without a basis for the concern. The purpose of the form is to identify which clients have risk factors; the fact that records are complete is less important than identifying at risk pregnancies. Although this is true, this statement is too vague to be the best response. It is best to explain specifically that the impact on the current pregnancy might put the pregnancy at higher risk)

The nurse is admitting a client at 28 weeks' gestation to the emergency department following an episode of domestic abuse resulting in ecchymosis and lacerations. Which question is most critical to ask? a. "Do you have a safe place where you can go?" b. "What did you do to make your spouse so angry?" c. "How many times has this happened in the past?" d. "Will you be pressing charges against your spouse?"

a (This question is the highest priority because having a safe place to go after leaving the hospital reduces the risk of a repeated attack and further injury to both mother and fetus. This statement is blaming and must be avoided to establish a trusting, therapeutic relationship with an abused client. Although domestic abuse tends to increase in frequency and violence during pregnancy, this is not the highest priority. Legal issues are a low priority at this time. Physiologic issues such as safety in the future have more importance.)

The nurse is preparing a client in her second trimester for a three-dimensional ultrasound examination. Which statement indicates that teaching had been effective? a. "I might be able to see who the baby looks like with the ultrasound." b. "If the ultrasound is normal, it means my baby has no abnormalities." c. "The nuchal translucency measurement will diagnose Down syndrome." d. "Measuring the length of my cervix will determine if I will deliver early."

a (Ultrasounds provide a very clear photo-like image of the fetus, often providing parents the opportunity to identify a familial characteristic such as nose shape. Not all fetal anomalies are detectable by ultrasound. Nuchal translucency measurements are screening, not diagnostic, for trisomies 13, 18, and 21. Transvaginal ultrasound is used to measure the cervical length as a screening for risk of preterm labor. However, a normal-length cervix does not preclude preterm birth.)

Which statement from the mother of a pregnant 13-year-old would be an expected response? a. "We had such high hopes for you." b. "I told you that boy was up to no good." c. "But she was always an easygoing child." d. "This is just one of those things that happen."

a (When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or disappointment. The degree of negative response will be determined by the age of the teen, the family expectations for the teen, and the presence or absence of other teen pregnancies in the family or support network. In early adolescence, the teen's mother frequently accompanies her daughter to prenatal examinations. The role of the nurse is to facilitate communication between mother and daughter and provide education for both. When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or disappointment. When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or disappointment. When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or disappointment.)

A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluate the client for diabetes? a. Conduct screening for type 2 diabetes mellitus as soon as possible. b. Begin serial testing of the client's serum glucose and HA1c at 24 weeks' gestation. c. If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM). d. Recognize HA1c equal to or greater than 4.5% or a fasting plasma glucose level equal to or greater than 90 mg/dL as being diagnostic of diabetes.

a (Women at high risk for type 2 DM should be screened for diabetes as soon as possible. Women at high risk for type 2 DM should be screened for diabetes as soon as possible. Women who are determined to have diabetes at this visit should be diagnosed as having overt diabetes and not GDM. HA1c equal to or greater than 6.5% would be considered diagnostic, as would a fasting plasma glucose level equal to or greater than 126 mg/dL or a 2-hour plasma glucose equal to or greater than 200 mg/dL during an oral glucose tolerance test (OGTT).)

A 38-year-old pregnant client is reluctant to attend prenatal classes because the other participants will be much younger. What should the nurse do to encourage this client's attendance at classes? Select all that apply. a. Support the client's strengths. b. Find a class with participants that are older. c. Encourage the client to read prenatal training material online. d. Nothing, since the client most likely has already researched the birthing process. e. Prepare a list of reasons for the late pregnancy to use as responses when others ask.

a and b (Even though women who are over age 35 and having their first baby tend to be better educated than other healthcare consumers, it should not be assumed that anticipatory guidance and support are not needed. Instead, support the client's strengths and be sensitive to her individual needs. Older expectant parents often feel uncomfortable in classes in which most of the participants are much younger. Because of this, classes for expectant parents over age 35 are now available in many communities. The client needs support and not just information that can be read over the Internet. The older client may be better informed. However, she still needs support. There is no reason for the client to have a list of excuses for delaying pregnancy.)

The nurse is preparing teaching for a pregnant client with a history of preterm labor. What information should the nurse specifically provide regarding sexual activity? Select all that apply. a. Avoid intercourse. b. Avoid nipple stimulation. c. Avoid intercourse if vaginal bleeding occurs. d. Avoid intercourse after the membranes rupture. e. There are no restrictions to intercourse during pregnancy.

a and b (Women with a history of preterm labor may be advised to avoid intercourse because the oxytocin that is released with orgasm stimulates uterine contractions and may trigger preterm labor. Because oxytocin is also released with nipple stimulation, fondling the breasts may also be contraindicated in women with a history of preterm labor. All pregnant women should be instructed to avoid intercourse if vaginal bleeding occurs. All pregnant women should be instructed to avoid intercourse after the membranes rupture. Women with a history of preterm labor may be advised to avoid intercourse because the oxytocin that is released with orgasm stimulates uterine contractions and may trigger preterm labor.)

A pregnant client with rheumatoid arthritis arrives for a prenatal examination. How should the nurse support this client's needs? Select all that apply. a. Assist with positioning on the examination table. b. Repeat teaching instructions slowly and succinctly. c. Assist with changing clothing for the examination. d. Permit the client privacy while preparing for the examination. e. Recommend delaying an examination until later in the pregnancy.

a and c (A client with arthritis might find examination positions uncomfortable. The nurse should assist this client with positioning. There is no need to repeat teaching instructions slowly and succinctly because the client does not have a learning disability. A client with arthritis might need assistance changing into an examination gown. An adolescent client would want privacy, more so than the client with a physical disability. The pregnant client with a disability should have the same amount and degree of prenatal care. Delaying examinations is not appropriate to suggest.)

The screening results of a quadruple screening completed on a 37-year-old pregnant client were not within the normal range. For which additional testing should the nurse prepare this client? Select all that apply. a. Ultrasound b. Serum glucose c. Amniocentesis d. Serum ferritin levels e. Fetal heart monitoring

a and c (If the screening results are not in the normal range, follow-up testing using ultrasound is often indicated. Serum glucose level is not used to detect fetal genetic abnormalities. If the screening results are not in the normal range, follow-up testing using amniocentesis is often indicated. Serum ferritin levels would measure iron level and will not detect fetal genetic abnormalities. Fetal heart monitoring will not detect fetal genetic abnormalities.)

The nurse is preparing a teaching guide to be used for prenatal, pregnancy, and postpartum nutritional classes. Which nutrients should the nurse emphasize that remain consistent throughout these gestational periods? Select all that apply. a. Fat b. Iron c. Protein d. Vitamin K e. Pyridoxine

a and d (Fat requirements are unchanged during pregnancy and should account for about 20% to 35% of daily caloric intake, of which 10% or less should be saturated fat. Iron requirements increase during pregnancy because of the growth of the fetus and placenta and the increased maternal blood volume. The protein requirement for a pregnant woman is 60 g/day, an increase of 14 g over nonpregnant levels. The recommended daily allowance (RDA) for vitamin K, 90 mcg per day, does not increase during pregnancy. The recommended daily allowance (RDA) during pregnancy for pyridoxine is 1.9 mg/day, an increase of 0.6 mg over the allowance for nonpregnant women.)

A 25-year-old client with a learning disability arrives for her first prenatal visit at week 24 of gestation. What should the nurse emphasize when caring for this client? Select all that apply. a. Ask if the client has any questions. b. Avoid rushing through the examination. c. Provide information in small increments. d. Ask who is going to financially assist the client. e. Suggest discussing the pregnancy with social services.

a, b, and c (The client may have a lower reading and comprehension level. Asking if the client has any questions will help with retention. The client will be anxious, which can be helped by not rushing through the examination. Providing information in small increments will help with comprehension. The client's financial situation is inappropriate for the nurse to assess. Women with intellectual disabilities are at increased risk of intervention by social services, which may result in the removal of the newborns from their custody. Discussing the pregnancy with social services will add to this client's anxiety.)

The nurse notes that a client who is 10 weeks pregnant is experiencing changes to the upper respiratory system. What should the nurse explain as being the reason for these changes? Select all that apply. a. Estrogen-induced edema b. Hypersecretion of mucus c. Decreased white blood cell production d. Vascular congestion of the nasal mucosa e. Amniotic fluid reducing total fluid volume

a, b, and d (Upper respiratory changes in the form of nasal stuffiness and epistaxis may occur because of estrogen-induced edema. Upper respiratory changes in the form of nasal stuffiness and epistaxis may occur because of hypersecretion of mucus. There is no change in white blood cell production. Upper respiratory changes in the form of nasal stuffiness and epistaxis may occur because of vascular congestion of the nasal mucosa. Amniotic fluid is not reducing the client's total fluid volume.)

A pregnant client diagnosed with Chlamydia trachomatis infection is refusing treatment. What effects on the fetus should the nurse explain might occur if treatment is waived? Select all that apply. a. Fetal death b. Premature labor c. Newborn conjunctivitis d. Chlamydial pneumonia e. Ophthalmia neonatorum

a, b, c, and d (Fetal death is a potential adverse effect of maternal untreated Chlamydia trachomatis infection. Premature labor is a potential adverse effect of maternal untreated Chlamydia trachomatis infection. An infant of a woman with untreated chlamydial infection may develop newborn conjunctivitis. An infant of a woman with untreated chlamydial infection may develop chlamydial pneumonia. Ophthalmia neonatorum is associated with gonorrhea.)

A pregnant client is reviewing the tentative buffet menu for her upcoming baby shower. Which items should the nurse suggest be substituted to ensure the health of the client and developing fetus? Select all that apply. a. Baked brie with crackers b. Greek salad with feta cheese c. Caesar salad with sourdough croutons d. Salmon pate with toasted bread rounds e. Grilled orange roughy with summer vegetables

a, b, c, and d (Soft cheese such as brie should be avoided because of the potential for harboring Listeria. Soft cheese such as feta should be avoided because of the potential for harboring Listeria. Salad dressings such as caesar are made with raw eggs, which should be avoided because of the potential for a Salmonella infection. Pates should be avoided because of the potential for harboring Listeria. There are no known bacterial infection issues associated with eating grilled orange roughy and summer vegetables while pregnant.)

The maternity nurse is planning to incorporate complementary and alternative therapies when providing care to clients in labor. What should the nurse do before implementing these therapies? Select all that apply. 1. Find evidence-based research for the use of the therapies. 2. Identify the therapies that are within the scope of nursing practice. 3. Document the use of therapies within the context of nursing practice. 4. List the therapies that are permitted according to the nurse practice act. 5. Determine which therapies are appropriate for a client's health problem.

a, b, c, and d (The use of complementary and alternative therapies should also be supported by evidence-based research. Nurses should use complementary modalities that are in the scope of their nursing practice. Nurses who use complementary modalities should document their use within the context of nursing practice. This is most effective when the modality is identified as an intervention to address a specific nursing diagnosis or an identified client need. Nurses should use complementary modalities that are in the nursing practice act in their state. Determining which therapies are appropriate for a client's health problem is beyond the nurse's scope of practice.)

A pregnant client is diagnosed with a cardiac problem. What should the nurse prepare to instruct this client to do, to ensure a safe pregnancy? Select all that apply. a. Restrict activities. b. Follow a diet high in iron and protein. c. Restrict the intake of sodium. d. Obtain 8 to 10 hours of sleep. e. Obtain pneumococcal vaccination

a, b, c, and d (To help preserve her cardiac reserves, the woman may need to restrict her activities. For the pregnant client with cardiac problems, the client should be instructed in the importance of a diet high in iron and protein. For the pregnant client with cardiac problems, the client should be instructed in the importance of a diet low in sodium. For the pregnant client with cardiac problems, 8 to 10 hours of sleep are essential. Because upper respiratory infections may tax the heart and lead to decompensation, the woman must avoid contact with sources of infection. A pneumococcal vaccination is not indicated.)

The nurse is preparing to perform an initial prenatal assessment of a pregnant client who recently immigrated to the United States. Which cultural aspects should the nurse include during the assessment of this client? Select all that apply. a. Birth rituals b. Nutritional practices c. Use of home remedies d. Expectations to return to work e. Beliefs about exercise and activity

a, b, c, and e (Birth rituals may vary according to cultural group and should be assessed. Nutritional practices may vary according to cultural group and should be assessed. Use of home remedies may vary according to cultural group and should be assessed. Expectations to return to work are part of anticipatory guidance, from which every pregnant client and family would benefit. Beliefs about exercise and activity may vary according to cultural group and should be assessed.)

During a phone call to the clinic the nurse suspects that a pregnant client is experiencing preeclampsia. What manifestations did this client report that caused the nurse to make this clinical determination? Select all that apply. a. Double vision b. Epigastric pain c. Facial swelling d. Painful urination e. Severe headache

a, b, c, and e (Double vision is a manifestation of preeclampsia. Epigastric pain is a manifestation of preeclampsia. Facial edema is a manifestation of preeclampsia. Dysuria is a manifestation of a urinary tract infection. Severe headache is a manifestation of preeclampsia.)

A pregnant client's quadruple screen shows a risk for the fetus to have Down syndrome. Which test results within the screen were used to make this determination? Select all that apply. a. Inhibin-A b. Alpha-fetoprotein (AFP) c. Unconjugated estriol (UE) d. Hemoglobin electrophoresis e. Human chorionic gonadotropin (hCG)

a, b, c, and e (Higher than normal levels of inhibin-A may indicate that a woman is at increased risk of having a baby with Down syndrome. Lower than normal AFP could indicate that the woman's child is at risk for Down syndrome or trisomy 18. Lower than normal UE may indicate that a woman is at increased risk of having a baby with Down syndrome. Hemoglobin electrophoresis is not a test within the quadruple screen. Higher than normal levels of hCG may indicate that a woman is at increased risk of having a baby with Down syndrome.)

The nurse is preparing a teaching session for staff nurses on cultural influences of childbearing practices. Which topics should the nurse include? Select all that apply. a. Gender of children b. Number of children c. Use of contraception d. Achievement of developmental milestones e. Pregnancy as an illness or expected condition

a, b, c, and e (In some cultures, a woman who gives birth achieves a higher status, especially if the child is male. In many cultures throughout the world, it is common to have as many children as possible. Culture may also influence attitudes and beliefs about contraception. In some cultures, contraception is appropriate but sterilization is not. Achievement of developmental milestones would be included with content about childrearing practices. Certain behaviors can be expected if a culture views pregnancy as a sickness, whereas other behaviors can be expected if the culture views pregnancy as a natural occurrence.)

The nurse notes a general increase in clients' use of complementary and alternative therapies. What should the nurse identify as reasons for the increase in these therapies? Select all that apply. a. Increased media attention b. The advent of the Internet c. Increased international travel d. The use of traditional Western medicine for treatment e. Increased consumer awareness of the limitations of conventional medicine

a, b, c, and e (Increased media attention has spotlighted complementary and alternative therapies. The advent of the Internet has made obtaining complementary and alternative therapies easier. Increased international travel has increased the awareness of complementary and alternative therapies. The use of traditional Western medicine for treatment often has stopped the use of complementary therapies and forced clients to hide the fact they use them from their healthcare providers. Increased consumer awareness of the limitations of current conventional medicine has increased the awareness of complementary and alternative therapies.)

The nurse is preparing a presentation on psychosocial issues of older pregnant clients. What should the nurse include in this presentation? Select all that apply. a. Social isolation b. Financial issues c. Pending mortality d. Managing adverse effects e. Family's and friends' attitudes

a, b, c, and e (Older couples facing pregnancy may feel isolated socially. They may feel different because they are often the only couple in their peer group expecting their first baby. The older couple is generally more financially secure, but when their "baby" is ready for college, the older couple may be close to retirement and might not have the means to provide for their child. The older couple may also be forced to face their own mortality. Older expectant parents may confront the issue earlier as they consider what will happen as their child grows. Managing adverse effects would be a part of a presentation on physiologic issues of older pregnant clients. The family's and friends' responses to the pregnancy may be mixed since it will affect relationships and lifestyle.)

The nurse notes that the majority of clients who signed up to attend prenatal classes are over the age of 35. What should the nurse consider as reasons why these clients are this age? Select all that apply. a. Age of marriage was later. b. More effective birth control methods. c. Waited until financially secure before having a family. d. Needed to care for aging parents before having a family. e. Wanted to become established in a career before having a family.

a, b, c, and e (Reasons for women choosing to have their first baby after age 35 include marrying later in life. Reasons for women choosing to have their first baby after age 35 include more effective birth control methods. Reasons for women choosing to have their first baby after age 35 include waiting until financially secure before having a family. Caring for aging parents is not identified as a reason for women choosing to have their first baby after age 35. Reasons for women choosing to have their first baby after age 35 include wanting to become established in a career before having a family.)

A 38-year-old client is thrilled to learn of being pregnant with her first child. What should the nurse identify as advantages for the client having a child at this age? Select all that apply. a. Most likely well-educated. b. Ready to make a life change. c. Decision was made deliberately. d. Child care will be easier at this age. e. Able to take on the responsibilities of a child.

a, b, c, and e (Single women or couples who delay childbearing until they are older tend to be well educated and financially secure. Some women are ready to make a change in their lives, wanting to stay home with a new baby. Usually, the decision to have a baby at an older age was deliberately and thoughtfully made. Because of their greater life experiences, they also are more aware of the realities of having a child and what it means to have a baby at this age. Child care will not be easier. Many of the women have experienced fulfillment in their careers and feel secure enough to take on the added responsibility of a child.)

A client in labor is demonstrating acute manifestations of schizophrenia. What should the nurse identify as a priority for this client? Select all that apply. a. Ensuring fetal well-being b. Ensuring maternal well-being c. Maintaining a safe environment d. Medicating for pain as necessary e. Considering pharmacologic intervention

a, b, c, and e (Some women with severe psychologic disorders may have excessive symptoms during their labor and birth. Care of these women should focus on ensuring fetal well-being. Some women with severe psychologic disorders may have excessive symptoms during their labor and birth. Care of these women should focus on ensuring maternal well-being. Some women with severe psychologic disorders may have excessive symptoms during their labor and birth. Care of these women should focus on maintaining a safe environment. Medicating for pain would be provided for all laboring clients, not just those experiencing acute manifestations of schizophrenia. Pharmacologic interventions may be necessary for excessive symptoms.)

The nurse is reviewing clients who would benefit from a biophysical profile (BPP). Which clients should the nurse identify as a priority? Select all that apply. a. A gravida who is postterm b. A gravida with intrauterine growth restriction c. A gravida with mild hypertension of pregnancy d. A gravida who is experiencing nausea and vomiting e. A gravida who complains of decreased fetal movement for 2 days

a, b, c, and e (The infant who is postterm might be compromised due to placental insufficiency. The infant who has intrauterine growth problems might be compromised due to placental insufficiency. The BPP is indicated when there is risk of placental insufficiency or fetal compromise because of maternal preeclampsia or eclampsia. Maternal nausea and vomiting is not a criterion for a BPP. The gravida who is experiencing decreased fetal movement for 2 days needs assessment of the placenta and the fetus.)

A 40-year-old client, pregnant with her first child, arrives for a prenatal visit. What perinatal risk factors should the nurse keep in mind when planning this client's care? Select all that apply. a. Miscarriage b. Maternal death c. Perinatal morbidity d. Potential for multiple births e. Maternal chronic health conditions

a, b, c, and e (The rate of miscarriage is higher in pregnant women over age 35. The risk of maternal death is higher for women over age 35 and even higher for women age 40 and older. The rate of perinatal morbidity is higher in pregnant women over age 35. There is no evidence to support that pregnant women over the age of 35 or 40 have a greater potential for multiple births. Women over the age of 40 and older are more likely to have chronic medical conditions that can complicate a pregnancy.)

A pregnant client is interested in the use of herbs during her pregnancy. How should the nurse counsel this client? Select all that apply. a. Do not take any herbs with other medication. b. Refer to the list to learn which herbs to avoid during pregnancy. c. Most herbs are harmless and can be safely taken while pregnant. d. Refer to the list to learn which herbs to avoid during breastfeeding. e. Consult with your healthcare provider before taking any herbs, even as teas.

a, b, d, and e (Certain herbs may interact with prescribed medication, and should not be used. Lists identifying common herbs that women are advised to avoid or use with caution during pregnancy are available. Most herbs are not harmless. They are not routinely regulated and should be treated with caution. Lists identifying common herbs that women are advised to avoid or use with caution during lactation are available.)

The nurse is reviewing with a pregnant client the skin changes that she might experience during gestation. What should the nurse include in this discussion? Select all that apply. a. Linea nigra b. Spider nevi c. Psoriatic lesions d. Striae gravidarum e. Melasma gravidarum

a, b, d, and e (Changes in skin pigmentation occurring during pregnancy are thought to be stimulated by increased estrogen, progesterone, and α-melanocytic-stimulating hormone levels. The skin in the middle of the abdomen may develop a pigmented line, the linea nigra, which usually extends from the pubic area to the umbilicus or higher. Vascular spider nevi, small, bright-red elevations of the skin radiating from a central body, may develop on the chest, neck, face, arms, and legs. They may be caused by increased subcutaneous blood flow in response to elevated estrogen levels. Psoriatic lesions are not typically associated with pregnancy. Striae gravidarum, or stretch marks, may appear on the abdomen, thighs, buttocks, and breasts. They result from reduced connective tissue strength because of elevated adrenal steroid levels. Changes in skin pigmentation occurring during pregnancy are thought to be stimulated by increased estrogen, progesterone, and α-melanocytic-stimulating hormone levels. Melasma gravidarum, also known as the "mask of pregnancy," a darkening of the skin over the forehead and around the eyes, may develop. Melasma is more prominent in dark-haired women and is aggravated by exposure to the sun.)

A client is suspected of having a hydatidiform mole. What should the nurse expect to assess in this client? Select all that apply. a. Elevated blood pressure b. Absence of fetal heart tones c. Frequent urination and thirst d. Dark brown vaginal drainage e. Larger than gestational age fundal height

a, b, d, and e (Manifestations of preeclampsia are associated with a hydatidiform mole, which would include an elevated blood pressure. Fetal heart sounds are absent with a hydatidiform mole because a fetus is not developing in the uterus. Frequent urination and thirst are not manifestations of hydatidiform mole. Dark brown vaginal discharge, similar to prune juice, occurs because of liquefaction of the uterine clot. Uterine enlargement greater than expected for gestational age is a classic sign of a complete mole, which is present in about half of cases. Enlargement is due to the proliferating trophoblastic tissue and to a large amount of clotted blood.)

A pregnant client is in a motor vehicle crash and needs surgery to repair a fractured lower leg. What special precautions will this client need during and after the surgery? Select all that apply. a. Prepare for intubation. b. Insert a nasogastric tube. c. Maintain on strict bed rest. d. Insert an indwelling urinary catheter. e. Apply sequential compression devices (SCDs).

a, b, d, and e (Pregnancy causes increased secretions of the respiratory tract and engorgement of the nasal mucous membrane, often making breathing through the nose difficult. Consequently, pregnant women often need an endotracheal tube to maintain an airway during surgery. The decreased intestinal motility and delayed gastric emptying that occur in pregnancy increase the risk of vomiting when anesthetics are given and during the postoperative period. A nasogastric tube may be recommended before major surgery. Exercises in bed should be encouraged along with early ambulation after surgery. An indwelling urinary catheter prevents bladder distention, decreases risk of injury to the bladder, and permits monitoring of output. SCDs during and after surgery help prevent venous stasis and the development of thrombophlebitis.)

During a prenatal visit the nurse notes that a client entering the third trimester has gained a total of 8 lb. What action should the nurse take at this time? Select all that apply. a. Assess for nausea. b. Refer to a dietitian. c. Suggest amniocentesis. d. Assess nutritional intake. e. Discuss importance of adequate weight gain.

a, b, d, and e (The nurse should assess for reasons that may restrict the client's intake, such as nausea. The nurse should refer the client to a dietitian for nutritional teaching. An amniocentesis is not indicated at this time. The nurse should discuss the importance of adequate nutritional intake. The nurse should discuss the importance of adequate weight gain to support the developing fetus.)

A client who is at 28 weeks' gestation arrives for her first prenatal examination in a wheelchair. What should the nurse include when assessing this client? Select all that apply. a. Signs of physical abuse b. Evidence of mental abuse c. Teaching about cesarean birth d. Reason why prenatal care was delayed e. Language that would hint toward financial abuse

a, b, d, and e (Women with disabilities are at greater risk of being victimized and of sustaining intimate partner violence. Women who rely on their partner for assistance with activities of daily living are at risk for physical abuse. Women with disabilities are at greater risk of being victimized and of sustaining intimate partner violence. Women who rely on their partner for assistance with activities of daily living are at risk for mental abuse. Pregnant women who use a wheelchair will not necessarily need a cesarean birth. Women with disabilities are at greater risk of being victimized and of sustaining intimate partner violence. Women who rely on their partner for assistance with activities of daily living are at risk for having care withheld. Women with disabilities are at greater risk of being victimized and of sustaining intimate partner violence. They are also at risk for financial abuse.)

The nurse is preparing an in-service presentation about the role of culture in adolescent pregnancy. What should the nurse include in this presentation? Select all that apply. a. "Teens with future goals tend to use birth control more consistently." b. "Most pregnant teens do not have any relatives who had their first child as teens." c. "Young teens who have a child are more likely to have another while still a teen." d. "Although the rate has dropped, non-Caucasian teens are more likely to become pregnant." e. "Eighty-five percent of teen mothers are middle class, and give birth to gain adult status."

a, c, and d (Teens with future goals such as college or a job tend to use birth control more consistently compared with other teens; if they become pregnant, they are also more likely to have abortions. Having a mother or a sister who had her first child during adolescence is a risk for a teen to become pregnant. When the first birth occurs in the early teen years, the next birth also is likely to occur prior to adulthood. In the United States, the adolescent birth rate is higher among African American teens and Hispanic teens than among Caucasian teens. When teens in poverty become pregnant, they are more likely to maintain the pregnancy and view the birth as a way to be seen as an adult. Middle-class teens are more likely to have future education and career goals, use contraception, and seek therapeutic abortion if they become pregnant.)

The nurse provides teaching on the signs of impending labor with a client at week 37 of gestation. Which client statements indicate that additional teaching would be beneficial? Select all that apply. a. "A bloody show means labor will begin within 2 days." b. "Having uterine contractions that increase over time is a sign of labor." c. "Uterine contractions that do not radiate to the back are a sign of labor." d. "Having a spontaneous flow of water from my vagina is a sign of labor." e. "Expulsion of a plug of mucus means the baby has dropped into the pelvis."

a, c, and e (Bloody show is a sign of impending labor, which will begin before 2 days. Uterine contractions that increase over time are a sign of impending labor. Uterine contractions that do not radiate to the back describe false labor. Spontaneous rupture of membranes is a sign of impending labor. Expulsion of a mucous plug is a sign of impending labor and not an indication that the fetus has dropped into the pelvis.)

The manager notes that a neonatal intensive care unit (NICU) nurse is practicing culturally competent care. What did the manager observe to make this decision? Select all that apply. a. Respects the rituals of the ethnic group of a new mother b. Explains the processes that are followed in an American hospital c. Speaks a few phrases in the language of a non-English-speaking client d. Discusses the odd practices that a client from Europe wants to have done e. Contacts an interpreter to facilitate communication with a Spanish-speaking client

a, c, and e (Evidence of cultural competence includes respecting the rituals of the client's ethnic group. Explaining the processes to be followed in an American hospital can be perceived as being ethnocentric behavior. Evidence of cultural competence includes learning the language, or at least several key phrases, of at least one of the cultural groups with whom the nurse interacts. Discussing a non-American client's odd practices could be perceived as being ethnocentric behavior. Evidence of cultural competence includes providing for the services of an interpreter if a language barrier exists.)

The nurse is reviewing a client's use of complementary and alternative therapies. Which situations should the nurse identify as being risky for the client? Select all that apply. a. Trying out a homeopathic medicine obtained from a friend to reduce swelling in the legs b. Joining a group that practices tai chi weekly to help with physical fitness and movement c. Taking an herbal preparation suggested by a health food store worker for treatment of leg pain d. Getting a massage from a licensed massage therapist for back pain, when such treatment has been prescribed by the primary healthcare giver e. Getting a chiropractic treatment for lower back pain due to discomforts of pregnancy without telling the primary healthcare provider

a, c, and e (Joining a group that practices tai chi weekly to help with physical fitness and movement is a perfectly good use of complementary therapies. Lack of standardization, lack of regulation and research to substantiate their safety and effectiveness, and inadequate training and certification of some healers make some therapies risky. Taking an herbal preparation suggested by a health food store worker for treatment of leg pain is a risk factor when considering these therapies. Getting a massage from a licensed massage therapist for back pain, when such treatment has been prescribed by the primary healthcare giver, is a perfectly good use of complementary therapies)

The nurse is evaluating the effectiveness of prenatal education provided to the spouse of a pregnant client. Which observations indicate that this education was effective? Select all that apply. a. Client is relaxed. b. Client and spouse are arguing. c. Spouse is looking forward to the birth. d. Spouse expresses fear of being a father. e. Client is following prenatal recommendations.

a, c, and e (Research indicates that increased focus on the father's needs during prenatal care improves the mother's stress levels. Arguing could indicate that the spouse is not transitioning to fatherhood and will affect the client's stress levels. Research indicates that increased focus on the father's needs during prenatal care aids his transition to fatherhood. Fear of being a father indicates that prenatal education was not effective in helping the spouse transition to fatherhood. Research indicates that increased focus on the father's needs during prenatal care improves the mother's prenatal health behavior.)

A client at 20 weeks' gestation is scheduled for a transabdominal ultrasound. What should the nurse instruct this client about the examination? Select all that apply. a. "The entire procedure takes between 20 and 30 minutes." b. "Arrive 30 minutes before the examination so pain medication will be effective." c. "Transmission gel will be spread over the abdomen during the examination." d. "Use an over-the-counter enema to empty the colon before the examination." e. "Drink 1.5 quarts of water 2 hours before the exam and refrain from voiding."

a, c, and e (Ultrasound testing takes 20 to 30 minutes. Ultrasound is a painless noninvasive diagnostic test. No anesthesia or pain medication is required prior to the procedure. Transmission gel is generously spread over the client's abdomen, and the sonographer slowly moves a transducer over the abdomen to obtain a picture of the uterine contents. It is not necessary to have an empty colon for an ultrasound. The bladder must be full for an ultrasound. The client should be instructed to drink 1 to 1.5 quarts of water 2 hours before the examination and refrain from voiding to ensure a full bladder.)

A client in the second trimester of pregnancy is experiencing severe heartburn. What should the nurse explain about the reasons for this health problem? Select all that apply. a. Decreased gastrointestinal motility b. Changes in carbohydrate metabolism c. Increased production of progesterone d. Relaxation of the esophageal sphincter e. Displacement of the stomach by the enlarging uterus

a, c, d, and e (Decreased gastrointestinal motility contributes to heartburn. Changes in carbohydrate metabolism contribute to the development of nausea and vomiting. The increased production of progesterone in pregnancy contributes to heartburn. Relaxation of the esophageal sphincter contributes to heartburn. Heartburn during pregnancy appears to be primarily a result of the displacement of the stomach by the enlarging uterus.)

The nurse is preparing prenatal teaching material to support the learning needs of a pregnant client with a learning disability. What should the nurse keep in mind when preparing these materials? Select all that apply. a. Provide with videotapes. b. Provide web site addresses. c. Allow for extra teaching time. d. Select an easy-to-understand format. e. Audiotape information from prenatal classes.

a, c, d, and e (Good communication aids such as videotapes should be used. The client has a learning disability and most likely will not be using a computer. Extra teaching time should be provided to ensure all learning needs are met. Easy-to-understand information will facilitate learning. Good communication aids such as audiotapes from prenatal classes should be used.)

The community nurse is providing prenatal care to a client in the home who has been unable to receive traditional prenatal care. Which barriers should the nurse consider when caring for this client? Select all that apply. a. Location of healthcare facilities b. View that prenatal care is insignificant c. Lack of transportation to healthcare facilities d. Appointment schedule conflicting with work hours e. Lack of support to care for other children while attending prenatal appointments

a, c, d, and e (Home care is especially effective in removing barriers for women who have difficulty accessing health care. A lack of locally available healthcare facilities is a barrier. Viewing that prenatal care is insignificant is not identified as a barrier to a woman having difficulty accessing health care. Home care is especially effective in removing barriers for women who have difficulty accessing health care. Lack of transportation to healthcare facilities is a barrier. Home care is especially effective in removing barriers for women who have difficulty accessing health care. Appointment schedule that conflicts with work hours is a barrier. Home care is especially effective in removing barriers for women who have difficulty accessing health care. Lack of support to care for other children while attending prenatal appointments is a barrier.)

The nurse is caring for clients in a major urban community health clinic. For which cultural groups should the nurse make assessing for lactose intolerance a priority? Select all that apply. a. Asians b. Mediterranean descent c. American Indians d. African Americans e. Mexican Americans

a, c, d, and e (Lactose intolerance is common in Asians. People of Mediterranean descent are not identified as having lactose intolerance. Lactose intolerance is common in American Indians. Lactose intolerance is common in African Americans. Lactose intolerance is common in Mexican Americans.)

The nurse is preparing teaching material on chorionic villus sampling (CVS) for a client who is entering the 10th week of gestation. What risks should the nurse include with this material? Select all that apply. a. Bleeding b. Embryonic puncture c. Intrauterine infection d. Inability to obtain a tissue sample e. Inadvertent rupture of the membranes

a, c, d, and e (Risks of CVS include bleeding. Embryonic puncture is not a risk associated with CVS. Risks of CVS include intrauterine infection. Risks of CVS include failure to obtain tissue. Risks of CVS include rupture of the membranes.)

The nurse is instructing a newly pregnant client who follows a vegan eating plan about folic acid. What should the nurse include when teaching the client about this nutrient? Select all that apply. a. The best sources are fresh green leafy vegetables. b. Overcooking foods high in folic acid is preferred. c. Foods high in folic acid should be protected from light. d. Cook foods high in folic acid with small amounts of water. e. Peanuts and whole-grain breads and cereals are good sources.

a, c, d, and e (Sources for folic acid include fresh green leafy vegetables. To prevent unnecessary loss, foods with folic acid should not be overcooked. To prevent unnecessary loss, foods with folic acid should be stored covered to protect them from light. To prevent unnecessary loss, foods with folic acid should be cooked with only a small amount of water. Sources of folic acid include peanuts and whole-grain breads and cereals, which are all appropriate for the vegan eating plan.)

The nurse is preparing to assess a client who is from a non-English-speaking culture. What should the nurse review about the client's culture before beginning the assessment? Select all that apply. a. Touch b. Employment c. Personal space d. Physical differences e. Use of nonverbal communication

a, c, d, and e (The appropriateness of touch varies with each culture. Employment is not culturally determined. An individual's sense of personal space differs by culture. Genetic and physical differences occur among cultural groups and can lead to disparity in needs and care. Depending upon the culture, gestures and body language may be misunderstood or misinterpreted.)

The nurse is caring for a pregnant client who has scoliosis that has affected sensation below the level of the umbilicus. What should the nurse instruct the client to do, to reduce the risk of adverse effects during pregnancy? Select all that apply. a. Walk slowly and deliberately. b. Limit the amount of daily exercise. c. Eat fewer calories to restrict weight gain. d. Ingest adequate amounts of fruits, vegetables, and water. e. Review signs of pending labor other than uterine contractions.

a, d, and e (Pregnancy may shift the center of gravity. For the client with lumbar scoliosis, this could cause the client to have difficulty maintaining balance with walking. Walking slowly and deliberately will reduce the risk of falling. There is no reason for the client to restrict the amount of daily exercise. Restricting weight gain while pregnant is not healthy for the client or fetus. Ingesting adequate amounts of fruits, vegetables, and water will prevent the development of constipation, which can occur when nervous innervation to the lower abdomen is affected. The client has reduced sensation below the level of the umbilicus and may not recognize or feel uterine contractions associated with pending labor. The nurse needs to review the other signs of pending labor, such as spontaneous rupture of membranes and bloody show.)

The nurse is reviewing amniocentesis with a pregnant client. In which order should the nurse explain the steps that will occur during this procedure? a. Conduct an ultrasound b. Fetal heart rate assessed c. Local anesthetic provided d. Skin cleansed with antiseptic solution e. Insertion site observed for fluid streaming f. 22-gauge needle inserted to withdraw amniotic fluid

a, d, c, f, e, b (An ultrasound is performed first to identify amniotic fluid pockets. Fetal heart rate is assessed last. A local anesthetic is provided after the skin is cleansed. Skin is cleansed after the ultrasound. Fluid streaming occurs after the 22-gauge needle is removed. A 22-gauge needle is inserted after the local anesthetic.)

Which client statement on cultural or religious influences on nutrition requires intervention? a. "I avoid milk and meat at meals because I am Jewish." b. "My auntie sent me clay from the south to eat every day." c. "Because I am Muslim, I do not ever eat any pork products." d. "My grandmother makes sure I eat a serving of greens each day."

b (A kosher diet involves avoiding pork and shellfish and not eating dairy and meat at the same meal. Eating clay is pica. The clay, being a type of soil, can be contaminated with hazardous substances and should be avoided. Some African Americans, especially those from the South, practice clay-eating pica. Dietary restrictions in the Muslim tradition include avoidance of pork. Because other meats are eaten, the client is not at risk for protein or iron deficiency. Greens, such as collard greens and spinach, have high amounts of folic acid and are healthy foods to eat during pregnancy. Women from the southern United States often eat greens.)

The nurse is teaching a couple pregnant for the first time. Which statement made by the couple about prenatal classes indicates that additional information is necessary? a. "Facilitate better communication between both partners." b. "Eliminate the risk of needing a vacuum extraction or cesarean birth." c. "Help parents cope with the discomforts and unknowns of childbirth." d. "Encourage participants to write a list of their requests for labor and birth."

b (A secondary goal of prenatal classes is to facilitate communication between the pregnant woman and her partner. The primary goals are to inform participants of the birth process and teach them skills to cope with labor and birth. This is false reassurance. There is no guarantee that an operative birth can be avoided, even if a couple attends prenatal classes. This is one of the main goals of prenatal classes: learning skills to help get through the discomforts of childbirth. Participants also learn how the birthing process progresses. Participants will learn new skills that will facilitate the birthing process. One of the strategies used in prenatal classes is to have participants write a birth plan that lists their requests for how they want their birthing experience to be. But putting their desires down in writing is less important than learning about the birth process and learning skills to cope with labor and delivery.)

The nurse is assessing a 25-year-old primigravida who is 20 weeks pregnant. Which vital signs finding should the nurse report immediately to the physician? a. Pulse 88/min b. Respirations 30/min c. Blood pressure 134/82 d. Temperature 37.4°C (99.3°F)

b (A slight increase in pulse is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism. Tachypnea is not a normal finding and requires medical care. The blood pressure is within normal limits. A slightly elevated temperature is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism.)

A 16-year-old is making her first prenatal visit to the clinic in her fourth month of pregnancy. What is the nurse's first responsibility? a. Contact the social worker. b. Develop a trusting relationship. c. Teach the client about proper nutrition. d. Schedule the client for prenatal classes.

b (A social worker might be able to provide assistance with financial program eligibility, support groups, or obtaining baby items such as furniture and car seats. The most important goal for the nurse caring for a pregnant adolescent is to be open minded and nonjudgmental in order to foster trust between the adolescent and the nurse. Through a trusting relationship, the nurse can provide counseling and education to the mother-to-be, both about her body and the fetus. Developing a trusting relationship with the pregnant adolescent is essential. Honesty, respect, and a caring attitude promote self-esteem. Although nutrition is an important physiologic need, without a trusting relationship, little teaching will occur because the teen will often "tune out" adults that she does not trust. Prenatal classes specifically designed for teen mothers and attended by only teen mothers facilitate both learning and support for the teens.)

A client who is 32 weeks pregnant is HIV positive, but asymptomatic. What would be important in managing her pregnancy and delivery? a. An amniocentesis at 30 and 36 weeks b. Weekly non-stress testing beginning at 32 weeks' gestation c. Administration of intravenous antibiotics during labor and delivery d. Application of a fetal scalp electrode as soon as her membranes rupture in labor

b (All invasive procedures that would expose the uninfected infant to the HIV virus are avoided. Clients who are HIV positive are considered high-risk pregnancies. Therefore, beginning at about 32 weeks, these clients have weekly non-stress tests to assess for placental function and an ultrasound every 2 to 3 weeks to assess for intrauterine growth retardation (IUGR). Antibiotics would be ineffective for either the mother or the infant who was HIV positive. All invasive procedures that would expose the uninfected infant to the HIV virus are avoided.)

The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8. Which statement indicates that additional teaching is necessary? a. "I need to increase food sources that contain iron." b. "If I drink lots of milk, I will increase my iron level faster." c. "My iron is low, but it will increase as I take iron supplements." d. "I might feel less energetic and tire more easily while my iron is low."

b (Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing iron-rich foods will improve anemia. Milk does not contain iron; it contains calcium. Increased calcium intake will not increase hemoglobin levels. Further, iron should not be taken with milk, as the iron will not be absorbed. Iron supplements are indicated with anemia. This client's hemoglobin level is 8; lower than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin. Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not adequately oxygenated, especially during activity, and fatigue results.)

The nurse has completed a presentation for newly pregnant women about the changes of pregnancy. Which participant's statement reflects accurate comprehension of the information? a. "Uterine souffle is a positive change of pregnancy." b. "A positive Goodell sign is a probable change of pregnancy." c. "Changes in the pelvic organs are presumptive signs of pregnancy." d. "Three positive pregnancy tests in a 1-week period is considered to be a positive change of pregnancy."

b (Because uterine souffle can be objectively identified but may be caused by conditions other than pregnancy, it is considered to be a probable change of pregnancy. A positive Goodell sign can be objectively identified but may also be caused by conditions other than pregnancy; therefore, it is considered to be a probable change of pregnancy. Changes in the pelvic organs can be objectively identified; however, because some pelvic organ changes may be associated with conditions other than pregnancy, they are considered to be probable changes of pregnancy. Because other conditions may cause elevated hCG, pregnancy tests are considered probable changes of pregnancy.)

An expectant couple is determining their compatibility with a healthcare provider. Which question should the nurse encourage the couple to ask first? a. "Can my children attend the birth?" b. "What is your philosophy of birth?" c. "If I have a cesarean birth, can my husband attend?" d. "What percentage of your clients have episiotomies?"

b (Children's attendance is a complement to the healthcare provider's philosophy. A thorough understanding of the healthcare provider's philosophy is essential to determining compatibility. A husband's presence at a cesarean birth is a complement to the healthcare provider's philosophy. Episiotomy percentages are a complement to the healthcare provider's philosophy.)

Which situation in the high-risk antepartal unit requires immediate intervention? a. Fetal monitoring is being performed on a client in her third trimester who is scheduled for a cholecystectomy tomorrow. b. A third-trimester client pregnant with twins who required an appendectomy yesterday is positioned in a supine position. c. Oxygen is being administered at 2 L via nasal cannula to a client in her third trimester who underwent a urolithotomy today. d. The client in her third trimester who returned from bowel resection surgery has a nasogastric tube attached to intermittent suction.

b (Fetal monitoring prior to, during, and after surgery on pregnant clients is important to assess the fetal condition. A client undergoing surgery in the third trimester should be positioned in a left lateral position or with a hip wedge placed under the right hip. Being supine will cause vena cava syndrome and hypotension, which in turn will decrease fetal oxygenation. Twin gestation, with the larger uterus and heavier uterine contents, makes vena cava syndrome more problematic. Oxygen is required during and after surgery during pregnancy to maintain adequate fetal oxygenation. Due to the decreased peristalsis of pregnancy, pregnant clients who undergo abdominal surgery are at risk for vomiting. A nasogastric tube is placed to prevent vomiting.)

The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement requires immediate intervention by the nurse? a. "When my nausea is bad, I will drink some ginger tea." b. "It is normal for my vaginal discharge to get green colored." c. "I will urinate less often during the middle of my pregnancy." d. "The fatigue I am experiencing will improve in the second trimester."

b (Ginger helps nausea, and is safe for use during pregnancy. Leukorrhea is an increase in white vaginal discharge and is an expected finding during pregnancy. Green discharge is not a normal finding and could indicate an infection. Further assessment is required for a client with green vaginal discharge. As the uterus rises in the pelvis during the second trimester, urinary frequency decreases. Urinary frequency increases again during the end of the third trimester as the fetal head descends into the pelvis. First-trimester fatigue is common; fatigue usually improves during the second trimester.)

The nurse is conducting a postpartum visit to a client who is formula-feeding her infant. Which client statement indicates that teaching about weight maintenance has been effective? a. "I have increased my caloric intake by 600 calories per day." b. "My dietician has set my weight loss goal at 1 to 2 pounds per week." c. "Instead of making another doctor's appointment, I started a diet that my best friend recommended." d. "My daily regimen includes taking extra vitamin A, vitamin C, and thiamine in order to meet my body's increased need for nutrients after pregnancy."

b (If the mother has a good understanding of nutritional principles, it is sufficient to advise her to reduce her daily caloric intake by about 300 kcal and to return to prepregnancy levels for other nutrients. Weight loss goals of 1 to 2 pounds (0.45 to 0.9 kg)/week are usually suggested for mothers who formula-feed. The woman should diet only under the guidance of her primary healthcare provider. After birth, the formula-feeding mother's dietary requirements return to prepregnancy levels.)

The nurse is preparing teaching on maternal-fetal ABO incompatibility for antepartum clients. Which statement should the nurse include in the teaching information? a. In most cases, ABO incompatibility is limited to type A mothers with a type B or O fetus. b. In most cases, ABO incompatibility is limited to type O mothers with a type A or B fetus. c. ABO incompatibility occurs as a result of the fetal serum antibodies present and interaction between the antigen sites on the maternal red blood cells (RBCs). d. Group A infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother's blood type.

b (In most cases, ABO incompatibility is limited to type O mothers with a type A or B fetus. The group B fetus of a group A mother and the group A fetus of a group B mother are only occasionally affected. In most cases, ABO incompatibility is limited to type O mothers with a type A or B fetus. The group B fetus of a group A mother and the group A fetus of a group B mother are only occasionally affected. The incompatibility occurs as a result of the maternal antibodies present in her serum and interaction between the antigen sites on the fetal red blood cells (RBCs). Group O infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother's blood type.)

The nurse wants to teach a child newly enrolled in English as a second language class about the importance of handwashing before meals and of not eating food dropped on the examination room floor. What is the best way to assimilate the nurse's cultural values about hygienic nutrition? a. Schedule a medical interpreter to accompany the client to his or her next visit. b. Have the child repeat her or his interpretation of the information that was taught. c. Provide written materials in English about hygiene and diet for the client to take home. d. Have the nurse model proper handwashing before examining the child and throw out the dropped cookie.

b (In working with families with limited English proficiency, it is optimal to have a medical interpreter present for the entire visit. When teaching has been done, the nurse has a responsibility to assess client understanding; thus, an interpreter at the next visit will not help the nurse or the client now. When an interpreter is not available, asking the client to repeat his or her understanding of what was taught reveals how concepts were understood. Written materials in English hold minimal value for clients with limited understanding. Assimilation is described as adopting and incorporating traits of the new culture within one's practices. Information must be understood before it is assimilated. The purpose of modeled behavior might be misunderstood if it is not accompanied by an explanation.)

The nurse is responding to phone calls. Which call should the nurse return first? a. 29 weeks' gestation, reports increased fetal movement b. 37 weeks' gestation, reports no fetal movement for 24 hours c. 32 weeks' gestation, reports decreased fetal movement for 2 days d. 35 weeks' gestation, reports decreased fetal movement for 4 hours

b (Increased fetal movement is not indicative of a problem. A lack of fetal movement in a fetus in the third trimester can indicate fetal hypoxia or fetal death. This client is the highest priority. Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, this client is not the highest priority. Although decreased fetal movement can indicate intrauterine growth restriction or fetal hypoxia, 4 hours is a very short amount of time to assess decreased fetal movement.)

A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the client has a correct understanding of her condition? a "The increased size of my uterus means that I am finally pregnant." b. "Because we heard the baby's heartbeat, I am undoubtedly pregnant." c. "Since I haven't felt the baby move yet, we don't know if I'm pregnant." d. "My last period was 2 months ago, which means I'm 2 months along."

b (Increased uterine size is a probable, or objective, change and does not conclusively verify pregnancy status. Hearing the fetal heart rate is a positive, or diagnostic, change of pregnancy. Fetal movement is a presumptive, or subjective, change of pregnancy. Absence or presence of the sensation of fetal movement is not a conclusive indicator of pregnancy status. Amenorrhea is a presumptive, or subjective, change and does not conclusively verify pregnancy status.)

The nurse seeks to involve the adolescent father in the prenatal care of his partner. What is the reason for this strategy? a. Improves the long-term outcome of the relationship b. Increases the self-care behaviors of the pregnant teen c. Avoids legal action by the adolescent father's family d. Avoids conflict between the adolescent father and pregnant teen

b (Involving the client's partner in prenatal care will not decrease the likelihood that this relationship will be short term. Involving the partner of a pregnant adolescent helps the mother-to-be feel more confident in her decision making and improves her self-confidence and self-esteem, which in turn will improve positive self-care behaviors. The nurse first must explore what the relationship is between the pregnant teen and the father. Relationships between adolescents tend to be short lived, and pregnancy is an added stressor for the couple. If the client desires the participation of her partner, the nurse should provide education and support appropriate to the age, knowledge, and developmental level of the adolescent father.)

A client in the third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? a. Limit activity for several days. b. Flex the foot to stretch the calf. c. Point the toes of the affected leg. d. Increase intake of protein-rich foods.

b (Limiting activity is not appropriate. Leg cramps are a common problem in pregnancy, resulting from an imbalance in the calcium-phosphorus ratio; pressure on nerves or decreased circulation in the legs from the enlarged uterus; or fatigue. Dorsiflexing the foot will stretch the calf muscles and will help relieve the cramps. Pointing the toes will exacerbate leg cramps. Protein intake does not affect leg cramps.)

The nurse receives a phone call from a client who thinks she is pregnant. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What is the client's estimated date of delivery (EDD)? a. January 10 b. January 17 c. December 3 d. November 13

b (Naegele's rule is to add 7 days to the last menstrual period (LMP) and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Naegele's rule is to add 7 days to the last menstrual period (LMP) and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Naegele's rule is to add 7 days to the last menstrual period (LMP) and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD. Naegele's rule is to add 7 days to the last menstrual period (LMP) and subtract 3 months. The LMP is April 10; therefore, January 17 is the EDD.)

A client says that she is taking a preparation that makes symptoms of a disease worse. Which type of complementary and alternative therapy is this client using? a. Naturopathy b. Homeopathy c. Herbal therapy d. Chinese medicine

b (Naturopathy is a form of medicine that utilizes the healing forces of nature and is commonly referred to as natural medicine. It is more precisely defined as a healing system that combines safe and effective traditional means of preventing and treating human disease with the most current advances in modern medicine. Homeopathy is a healing approach in which a sick person is treated with small doses of medicines that would cause illness when given to someone who is healthy. Herbs do not usually cause symptoms when taken. Chinese medicine uses a variety of techniques including acupuncture, acupressure, and herbal therapy.)

A 20-year-old client who is at 10 weeks' gestation confides that the pregnancy was unplanned and is unsure about continuing it or sharing news about it with her partner. How should the nurse respond to this client? a. "You should go to a pregnancy support group to be a good mother." b. "It's common to feel ambiguous about pregnancy in the first trimester." c. "These thoughts are because your mother died when you were 4 years old." d. "It's really unusual for a pregnant woman to feel this way early in the pregnancy."

b (No psychopathology is present, so a support group is not indicated. Ambivalence toward the pregnancy is very common in the first trimester. Loss of the client's own mother at a young age would not affect the occurrence of ambivalence in the first trimester. Fathers might not be told immediately about the diagnosis of pregnancy)

A pregnant client asks what kinds of medications cause birth defects. Which statement would best answer this question? a. "Almost all medications will cause birth defects in the first trimester." b. "To be safe, do not take any medication without talking to your doctor." c. "Too much vitamin C is one of the most common issues but is avoidable." d. "Birth defects are very rare. Do not worry; your healthcare provider will watch for problems."

b (Not all medications are teratogenic. Pregnant women need to avoid all medications—prescribed, homeopathic, or over-the-counter—if possible. Vitamin C can cause rebound scurvy but is not teratogenic. The nurse should avoid a "do not worry" answer to ensure therapeutic communication, but it is appropriate to instruct the client to talk to the doctor about medications.)

A client with a normal prepregnancy weight asks why she has been told to gain 25 to 35 pounds during her pregnancy, but her underweight friend was told to gain 28 to 40 pounds. What should the nurse explain as being the recommended weight gain during pregnancy? a. More than 25 to 35 pounds for an overweight client b. More than 25 to 35 pounds for an underweight woman c. 25 to 35 pounds, regardless of a client's prepregnancy weight d. The same for a normal-weight woman as for an overweight woman

b (Overweight women should gain 15 to 25 pounds during pregnancy. Underweight women are encouraged to gain 28 to 40 pounds during pregnancy Prepregnancy weight determines the recommended weight gain during pregnancy. Women of normal weight should gain 25 to 35 pounds during pregnancy for optimal fetal outcome.)

The nurse has been asked by a community organization to give a presentation on prevention of teen pregnancy. Which statement indicates appropriate steps toward reduction of the local teen pregnancy rate? a. Classes on how to parent will be mandatory in high school. b. Plans are made to create a low-cost reproductive health clinic. c. Parents will be encouraged to avoid discussing sexual activity. d. Abstinence-only education will be offered in the school and clinics.

b (Parenting classes for teens who are neither pregnant nor parents do not address reducing teen pregnancy. Confidential, low-cost contraceptive education and services are most likely to increase contraceptive use by teens who are sexually active and therefore decrease teen pregnancy rates. Parents are the biggest influence on teens' decisions to begin or avoid sexual activity. Parents should be encouraged to talk openly and frankly with their teens about their views on sex, contraception, and abstinence. Abstinence first with information on contraception is most effective in reducing teen pregnancy rates.)

The nurse is planning a community adolescent pregnancy prevention program aimed toward parents. Which recommendation should be included in the program in order to be effective? a. Parents should encourage steady dating. b. Parents should not allow their son to develop an intense relationship with a girl who is much younger. c. Rather than embarrassing an adolescent by addressing specific topics related to sex, parents should speak in broad, general terms. d. Instead of bringing up the topic of sex, parents should allow their children to reach a point where the children initiate the discussion.

b (Parents need to clearly discourage early dating as well as frequent and steady dating. Parents should take a strong stand against allowing a daughter to date a much older boy; nor should they allow a son to develop an intense relationship with a much younger girl. Parents should be specific in their discussions about sex. Parents need to talk with their children about sex early and often and be specific in the discussions.)

A newly diagnosed type 1, insulin-dependent diabetic with good blood sugar control at 20 weeks' gestation asks how the diabetes will affect the baby. How should the nurse respond? a. "Your baby may be smaller than average at birth." b. "Your baby will probably be larger than average at birth." c. "Your baby might have high blood sugar for several days." d. "As long as you control your blood sugar, your baby will not be affected at all."

b (Poorly controlled type 1 diabetics who have developed vascular problems will have infants who are small-for-gestational-age (SGA) due to placental insufficiency. The infant of a diabetic mother produces excessive amounts of insulin in response to the high blood sugar. This hyperinsulinism stimulates growth (or macrosomia) in the infant because the infant utilizes the glucose in the bloodstream. Within minutes of delivery, the baby of an insulin-dependent diabetic can begin to develop low blood sugar. The demands of pregnancy will make it difficult for the best of clients to control blood sugar on a regular basis.)

The nurse is preparing a class for expectant fathers. Which information should the nurse include? a. Siblings adjust readily to the new baby. b. Sexual activity is safe for normal pregnancy. c. The expectant mother decides the feeding method. d. Fathers are expected to be involved in labor and birth.

b (Siblings often have difficulty adapting to the arrival of a new baby. Regression is often seen in siblings' behaviors. During a normal pregnancy, sexual activity is safe for both mother and baby. Often, the father wants input into the feeding method. In some cultures, labor and birth are only for women, and it is inappropriate for fathers to be involved with the labor and birth.)

A client of Hmong descent who immigrated to the United States 5 years ago asks for the regular hospital menu because she likes American food. To which cultural concept should the nurse attribute this client's request? a. Stereotyping b. Acculturation c. Enculturation d. Ethnocentrism

b (Stereotyping is assuming that all members of a group have the same characteristics. Acculturation (assimilation) is the correct assessment because the client adapted to a new cultural Enculturation is when culture is learned and passed on from generation to generation, and often happens when a group is isolated. Ethnocentrism refers to a social identity that is associated with shared behaviors and patterns.)

A pregnant woman is having a nipple-stimulated contraction stress test. Which result indicates hyperstimulation? a. There are more than five fetal movements in a 10-minute period. b. There are more than three uterine contractions in a 6-minute period. c. The fetal heart rate accelerates when contractions last up to 60 seconds. d. The fetal heart rate decelerates when three contractions occur within a 10-minute period.

b (The fetal movement is considered a negative contraction stress test. An equivocal or suspicious test has nonpersistent late decelerations or decelerations associated with hyperstimulation (contraction frequency of every 2 minutes or duration lasting longer than 90 seconds). When this test result occurs, more information is needed. The acceleration of the heart rate is considered a negative contraction stress test. Decelerations are considered a positive contraction stress test.)

A client in the first trimester of pregnancy is experiencing nausea. What should the nurse suggest the client do to relieve the nausea? a. Eat spicy foods. b. Eat small, frequent meals. c. Avoid carbonated beverages. d. Wait to eat for 2 hours in the morning.

b (The nausea of pregnancy can be exacerbated by ketosis, fatigue, and certain foods, such as those containing caffeine or spices. Avoiding severe hunger by eating small, frequent meals throughout the day can help to prevent or decrease the severity of the nausea. Carbonated beverages might be helpful in decreasing nausea. Eating dry carbohydrates prior to rising each day can help to prevent or decrease the severity of the nausea.)

What should the nurse do when assisting a pregnant client who is having an abdominal ultrasound to determine fetal age? a. Has the woman empty her bladder before the test begins b. Assists the woman into a supine position on the examining table c. Asks the woman to sign an operative consent form prior to the procedure d. Instructs the woman to eat a fat-free meal 2 hours before the scheduled test time

b (The recommendation is that the client should have a full bladder to help elevate the uterus out of the pelvic cavity for better visualization. Clients are placed in a supine position on the table. Abdominal ultrasounds are not invasive procedures and do not require a consent form. Dietary intake is not relevant to the ultrasound.)

During a prenatal examination the healthcare provider is going to estimate the adequacy of the client's pelvis for birth. Which measurement will the physician perform vaginally? a. True conjugate b. Diagonal conjugate c. Obstetric conjugate d. Transverse outlet diameter

b (The true conjugate is a measurement of the pelvic inlet and cannot be directly measured. The diagonal conjugate is measured from the lower edge of the symphysis to the sacral promontory. The obstetric conjugate is a measurement of the pelvic inlet and cannot be directly measured. The transverse outlet diameter is measured externally.)

A newly admitted client at 32 weeks' gestation is experiencing a sudden onset of intense nausea and a frontal headache for the past 2 days. The client's initial blood pressure is 158/98, and she reports scant urination over the past 24 hours. Which intervention should the nurse anticipate implementing? a. Ordering a low-protein diet for the client b. Conducting a urine dipstick test to assess for proteinuria c. Placing a wedge under the client's left hip so that she is in a right lateral tilt position d. Administering diuretics and facilitating a dietary regimen of strict sodium restriction

b (This client's signs and symptoms are consistent with preeclampsia. Dietary interventions include moderate to high protein intake (80 to 100 g/day, or 1.5 g/kg/day) to replace protein lost in the urine. This client's signs and symptoms are consistent with preeclampsia. Treatment includes daily urine dipstick testing to assess for proteinuria. This client's signs and symptoms are consistent with preeclampsia. Appropriate interventions include instituting bed rest with the client positioned primarily on her left side, to decrease pressure on the vena cava, thereby increasing venous return, circulatory volume, and placental and renal perfusion. This client's signs and symptoms are consistent with preeclampsia. Treatment includes avoidance of excessively salty foods, but sodium restriction and diuretics are no longer used in treating preeclampsia.)

The nurse is working with a prenatal client. Which statement indicates that additional teaching about prenatal screening tests is necessary? a. "My blood will be checked for hemoglobin level." b. "Because I am married, I won't have the STI screening." c. "My vagina will be cultured at 36 weeks for group B strep." d. "I will have Rh testing, even though this is my first pregnancy."

b (This is a true statement. All women will have their hemoglobin assessed. All women should be screened for syphilis, gonorrhea, and hepatitis B. This is a true statement. Women are tested for group B strep to prevent neonatal infection. This is a true statement. All clients are screened for blood type, Rh factor, and Rh antibodies, regardless of how many previous pregnancies (if any) they have had.)

The nurse is completing an assessment for a prenatal visit. Which client statement indicates that further teaching is necessary? a. "Now that I've felt fetal movement, I should feel movement regularly." b. "Because I'm in my third trimester, I should return to the clinic in a month." c. "Alcohol is possibly harmful to my baby, even at the end of my pregnancy." d. "Before I take any over-the-counter medications, I should contact my doctor."

b (This is a true statement. Once fetal movement is perceived, it should be felt regularly. Initially, this might not be every day, but in the third trimester, fetal movement should be noticeable several times per day. This statement is incorrect because prenatal visits during the third trimester are every 2 weeks from 26 to 36 weeks, and every week from 36 weeks to delivery. This is a true statement. Alcohol should be avoided throughout pregnancy and lactation. This is a true statement. Regardless of the gestational age, over-the-counter medications can have deleterious effects on the mother or baby; thus, it is important for a pregnant woman to consult her healthcare provider prior to taking any over-the-counter medications throughout the pregnancy.)

A pregnant client in the 21st week of pregnancy is planning a vacation with family and asks which method of travel she should use. How should the nurse respond? a. "Travel by bus." b. "Fly on an airplane." c. "Take an automobile." d. "Do not travel this late in the pregnancy."

b (Traveling by bus is similar to traveling by automobile, which does not allow for frequent enough ambulation. As pregnancy progresses, long-distance trips are best taken by plane. Automobile travel does not allow for frequent enough ambulation. It is not necessary to cease travel altogether.)

The nurse is working in a clinic where children from several cultures are seen. What should the nurse do as a first step toward the goal of personal cultural competence? a. Enhance cultural skills. b. Gain cultural awareness. c. Seek cultural encounters. d. Acquire cultural knowledge.

b (Ways to enhance cultural skill include learning a prevalent language or learning how to recognize health-manifesting skin color variations in different races. Without cultural awareness, healthcare givers tend to project their own cultural responses onto foreign-born clients; clients from different socioeconomic, religious, or educational groups; or clients from different regions of the country. During daily interactions with clients from diverse backgrounds, these cultural encounters allow the nurse to appreciate the uniqueness of individuals from varying backgrounds. Acquiring cultural knowledge includes studying information about the beliefs, biologic variations, and favored treatments of specific cultural groups. This would be important; however, it is not the first step toward the goal of personal cultural competence.)

The nurse suspects that a pregnant client is a substance user. Which approach should the nurse take during the health history? a. Explaining how harmful drugs can be for her baby. b. Asking the woman directly, "Do you use any street drugs?" c. Asking the woman if she would like to talk to a counselor. d. Asking some questions about over-the-counter medications and avoiding the mention of illicit drugs.

b (When talking to clients in a therapeutic manner, it is important not to be threatening or judgmental. Explaining how harmful drugs can be for her baby is an example of being judgmental. The best method of finding out if a client is using substances is to be direct and ask the question in a direct fashion without prejudice, bias, or negative body language. Lack of judgmental attitudes/body language typically results in honest answers. It is the responsibility of the nurse to question the client. It is the responsibility of the nurse not to avoid the issue.)

The nurse is working with a child whose religious beliefs differ from those of the general population. What should the nurse do to meet the specific spiritual needs of this child and family? a. Ask, "What do you think caused the child's illness?" b. Show respect while allowing time and privacy for religious rituals. c. Identify healthcare practices forbidden by religious or spiritual beliefs. d. Ask, "How do the child's and family's religious/spiritual beliefs impact their practices for health and illness?"

b (Whenever possible the nurse should attempt to accommodate religious rituals and practices requested by the family.)

A woman who is at 12 weeks' gestation asks the nurse if she can undergo chorionic villus sampling (CVS) testing in order to determine whether her baby has a neural tube defect. Which response is best? a. "No, because CVS testing is not performed until after 20 weeks' gestation." b. "No, because CVS testing alone at any stage cannot detect neural tube defects." c. "Yes, at 12 weeks' gestation, CVS can be used to diagnose a neural tube defect." d. "Yes, at 12 weeks' gestation, CVS is combined with amniocentesis to diagnose neural tube defects."

b (While CVS is typically performed between 10 and 13 weeks' gestation, this test cannot detect neural tube defects. Because CVS testing is performed so early in the pregnancy, it cannot detect neural tube defects. CVS is typically performed between 10 and 13 weeks' gestation; however, CVS does not detect neural tube defects. CVS is typically performed between 10 and 13 weeks' gestation; however, amniocentesis is not performed until 15 weeks' gestation.)

A woman at 30 weeks' gestation and a history of sickle cell anemia is experiencing fever, chills, and diarrhea for 3 days. What are the most serious potential complications that this client faces? a. Severe lethargy b. Sickle cell crisis c. Electrolyte imbalance d. Fetal neural tube defects

b (While the client may develop severe lethargy, her greatest risk concerns development of sickle cell crisis. Dehydration and fever can trigger sickling and crisis; for this reason, maternal infections are treated promptly. While the client may experience electrolyte imbalance, sickle cell crisis is the most serious potential complication of dehydration and fever. Fever, chills, and dehydration in the client with sickle cell anemia are not associated with an increased incidence of neural tube defects.)

A woman who is at 15 weeks' gestation received normal chorionic villus sampling (CVS) results and abnormal quadruple screen test results. For detection of congenital anomalies, which test should the nurse expect the woman to be offered next? a. Ultrasound b. Amniocentesis c. Non-stress test (NST) d. Contraction stress test (CST)

b (While ultrasound has many uses, it is not useful in the diagnosis of congenital anomalies. Women who have a normal CVS and an abnormal quadruple screen test would be offered amniocentesis to screen for congenital anomalies. The non-stress test is used to assess fetal status. The contraction stress test is used to assess fetal status.)

The nurse suspects that a pregnant client is experiencing effects to the gastrointestinal system because of elevated progesterone levels. What did the nurse assess to make this clinical determination? Select all that apply. a. Nausea b. Bloating c. Diarrhea d. Vomiting e. Constipation

b and e (Nausea is common during the first trimester and may result from several factors, including elevated human chorionic gonadotropin (hCG) levels, relaxation of the smooth muscle of the stomach, and changed carbohydrate metabolism. Elevated progesterone levels cause smooth muscle relaxation, resulting in delayed gastric emptying and decreased peristalsis. As a result the pregnant woman may complain of bloating. Diarrhea is not an expected effect of pregnancy on the gastrointestinal system. Vomiting is common during the first trimester and may result from several factors, including elevated human chorionic gonadotropin (hCG) levels, relaxation of the smooth muscle of the stomach, and changed carbohydrate metabolism Elevated progesterone levels cause smooth muscle relaxation, resulting in delayed gastric emptying and decreased peristalsis. As a result the pregnant woman may complain of constipation.)

A pregnant woman is being excavated from the back seat of a motor vehicle after a crash. In which order should this victim receive emergency care? a. Apply oxygen. b. Establish an airway. c. Monitor fetal activity. d. Position on the left side. e. Administer intravenous fluids.

b, a, e, d, c (Applying oxygen occurs after an airway is established. The first action is to establish an airway. Monitoring fetal activity occurs after the victim is stabilized. Positioning on the left side helps prevent hypotension. Intravenous fluids are provided to prevent shock and maintain circulation.)

The nurse is concerned that a pregnant client is experiencing depression. Which potential health issues should the nurse include when planning care for this client? Select all that apply. a. Alcohol use b. Preterm birth c. Poor appetite d. Poor weight gain e. Antenatal hemorrhage

b, c, and d (A pregnant client with bipolar disorder is at risk for alcohol use. A pregnant client with depression is at risk for preterm birth. A pregnant client with depression is at risk for poor appetite. A pregnant client with depression is at risk for poor weight gain. A pregnant client with schizophrenia is at risk for antenatal hemorrhage)

During a home visit the nurse observes a pregnant client assess fetal activity. Which observations indicate that the client understands the correct process for this count? Select all that apply. a. Sits in a chair b. Assumes a side-lying position c. Counts the same time every day d. Watches television while counting e. Begins counting 1 hour after a meal

b, c, and e (The client should be in a side-lying position when assessing fetal activity. A side-lying position is the position for assessing fetal activity. The count should be conducted the same time every day. The environment should be quiet during the count. The count should occur about 1 hour after a meal.)

A client's amniocentesis results indicate that the fetus is at risk for respiratory distress. What testing values support this clinical decision? Select all that apply. a. Amniotic glucose level 50 mg/dL b. Phosphatidylglycerol (PG) negative c. Lecithin/sphingomyelin (L/S) ratio 1:6 d. Amniotic fluid red blood cell count 5 mg/dL e. Lamellar body counts (LBCs) 5000/counts/mcL

b, c, and e (There is no information to support the use of amniotic fluid glucose level to predict respiratory functioning. The absence of phosphatidylglycerol (PG) indicates the fetal lungs are not mature. Lecithin and sphingomyelin are two components of surfactant. Early in pregnancy, the sphingomyelin concentration in amniotic fluid is greater than the concentration of lecithin, and so the L/S ratio is low (lecithin levels are low and sphingomyelin levels are high). This can result in the development of respiratory distress syndrome (RDS). There is no information to support the use of amniotic fluid red blood cell counts to predict respiratory functioning. When the LBC is 30,000 to 40,000 counts/mcL, probable lung maturity is assumed.)

A pregnant client is hesitant to have nuchal translucency testing. What should the nurse explain as being the advantages of having this test? Select all that apply. a. It has a high false-positive rate. b. It is performed early in the pregnancy. c. There is no risk of spontaneous abortion. d. It provides reassurance of the fetus's development. e. It accurately detects 90% of Down syndrome fetuses.

b, c, d, and e (A high false-positive rate would be a disadvantage of this test. Nuchal translucency testing can be performed in the first trimester to determine if a fetus is at risk for chromosomal disorders. Since it is noninvasive, there is no risk of spontaneous abortion. A normal result can provide reassurance to the woman that her baby most likely does not have a chromosomal disorder. Nuchal translucency testing accurately detects 90% of fetuses with Down syndrome.)

A 32-year-old pregnant client is diagnosed with active tuberculosis (TB). What fetal health issues is this client at risk for developing? Select all that apply. a. Cleft palate b. Preterm labor c. Microcephaly d. Spontaneous abortion e. Suboptimal weight gain

b, d, and e (Infants of women taking prednisone or prednisolone for rheumatoid arthritis during the first trimester have a slightly increased risk of cleft palate. Women with TB have a higher rate of preterm labor. Women with untreated hyperphenylalaninemia have an increased incidence of microcephaly. Women with TB have a higher rate of spontaneous abortion. Women with TB have a higher rate of suboptimal weight gain.)

A client is identified as having hepatitis B surface antigen (HBsAG) early in her pregnancy. Which client statement about the labor and birth process and having hepatitis B infection indicates the need for additional teaching? a. "Breastfeeding is a good feeding method for my baby." b. "My baby will get a bath as soon as its temperature is stable." c. "An internal fetal monitor will be applied as soon as possible during labor." d. "Two shots will be given to my baby to prevent transmission of hepatitis B."

c (1. Breastfeeding is not contraindicated in a client with HBsAG. 2. The presence of HBsAG indicates that the client is contagious for and capable of transmitting hepatitis B. Perinatal transmission is most likely to occur at the time of birth; thus, measures are taken to prevent exposing the fetus to the mother's blood and body fluids and to clean the baby's skin thoroughly of fluids as soon as possible after birth. 3. An internal fetal monitor will be avoided. 4. A newborn of a mother with HBsAG will receive an injection of hepatitis B immune globulin and a hepatitis B vaccine injection.)

Which client should the nurse identify as being a multipara? a. A client at 28 weeks' gestation with no previous pregnancies b. A client at 32 weeks' gestation who previously delivered one term infant c. A client at 13 weeks' gestation who previously delivered two term infants d. A client at 34 weeks' gestation who previously had one spontaneous abortion

c (A woman who has had no births at more than 20 weeks' gestation is considered a nullipara. A woman who has had one birth at more than 20 weeks' gestation, regardless of whether the infant was born alive or dead, is considered a primipara. A woman who has had two or more births at more than 20 weeks' gestation is considered a multipara. A woman who has had no births at more than 20 weeks' gestation is considered a nullipara.)

A woman at 28 weeks' gestation reports not feeling the baby move for over 30 minutes. How should the nurse respond first? a. "When did you eat last?" b. "Have you been smoking?" c. "Your baby might be asleep." d. "You need to go to the emergency room immediately for further evaluation."

c (After meals, an infant typically is active and moving. Smoking typically will stimulate the infant. Lack of fetal activity for 30 minutes typically is insignificant and means only that the infant is sleeping. The mother should continue to observe for fetal movements over the next 2.5 hours. If a lack of fetal movements continues, she should contact the healthcare provider. The mother would need to come to be examined if there had been no fetal activity for several hours.)

A client in the prenatal clinic believes she is pregnant because she has not menstruated for 3 months, and her breasts are getting bigger. What response by the nurse is best? a. "Lack of menses and breast enlargement are presumptive signs of pregnancy." b. "The changes you are describing are definitely indicators that you are pregnant." c. "Lack of menses can be caused by many things. We need to do a pregnancy test." d. "Breast and menstrual changes are positive signs of pregnancy. Congratulations."

c (Although this is true, amenorrhea and breast enlargement also can be caused by weight gain and other conditions. A pregnancy test is needed to determine whether the client is pregnant. This statement is false because amenorrhea and breast enlargement are presumptive signs of pregnancy because they can be caused by other conditions. This is a true statement and addresses that these changes could be caused by things other than pregnancy. This statement is false because amenorrhea and breast enlargement are presumptive signs of pregnancy. It is too early to determine if congratulations are in order.)

A client who is at 10 weeks' gestation is concerned about the amount of saliva that is in her mouth since she seems to be spitting when she talks. How should the nurse respond? a. "You should avoid astringent mouthwashes and chewing gum." b. "That's called ptyalism, and it's usually caused by increased salt intake during the second trimester." c. "Excess salivation commonly occurs during the first trimester, although the cause is unknown." d. "Let's schedule you for a doctor's appointment, because excessive salivation can signal a complication of pregnancy."

c (Astringent mouthwashes, chewing gum, and sucking hard candy may help relieve the bitter taste that often accompanies ptyalism. Ptyalism, which is excess production of saliva, usually occurs during the first trimester and the cause is unknown. Ptyalism, which is excess production of saliva, commonly occurs during the first trimester and the cause is unknown. Excess salivation, also called ptyalism, is a normal occurrence in women during the first trimester.)

The nurse is explaining the importance of fetal activity assessment to a pregnant client. What should the nurse do to best reinforce the significance of fetal kick monitoring? a. Perform daily phone calls to the client at work or home. b. Ask the client to remember to count the fetal movements. c. Explain the reason for counting fetal movement to the client. d. Review the client's written record of fetal movement at each visit.

c (Daily phone calls would take emphasis away from the importance of the client's counting of fetal movement. Writing down the count is more accurate than the client's simply remembering. When the nurse examines the written record the client has kept, it reinforces the importance of the record and improves the likelihood of continued record keeping. Many healthcare providers encourage pregnant women to monitor their unborn child's well-being by regularly assessing fetal activity beginning at 28 weeks' gestation. Vigorous activity generally provides reassurance of fetal well-being, but a marked decrease in activity or cessation of movement may indicate a problem that needs immediate evaluation. Knowing the reasons for the counting will increase understanding of the process but will not reinforce the significance of the task.)

A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What should the nurse expect to see in the medical record? a. Dyspnea and chest pain with mild exertion b. Elective cesarean birth scheduled for 37 weeks c. Discussed need for labor epidural and vacuum extraction d. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally

c (Dyspnea and angina with mild exertion are not expected with class II heart disease even during pregnancy, but are symptoms seen in class IV heart disease. Cesarean birth is only undertaken in cardiac clients for fetal or maternal intrapartal indications, not for cardiac reasons alone. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth. 3+ pre-tibial edema is never an expected finding during pregnancy. Pulse over 100 and respiratory rate over 24 are indicators of cardiac decompensation.)

The nurse is preparing a prenatal class about infant feeding methods to include maternal nutritional requirements for breastfeeding and formula-feeding. What statement should the nurse include? a. "Formula-feeding mothers need a high protein intake to avoid fatigue." b. "Producing breast milk requires calories, but any source of food is fine." c. "Breastfeeding requires a continued high intake of protein and calcium." d. "Formula-feeding mothers should protect their health with a lot of calcium."

c (Formula-feeding moms do not need additional nutrients. Although any food source would provide the additional calories, these needs are best met by using increased protein intake as the source for the required additional calories to support milk production. Lactation requires calories, along with increased protein and calcium intake. Formula-feeding mothers do not need additional nutrients)

The pregnant client's prenatal record indicates that she is a gravida 4 para 2022. How should the nurse interpret these data about the client? a. Is pro-abortion b. Has four living children c. Delivered two term infants d. Delivered two infants preterm

c (In the four-digit number, the third digit indicates the number of abortions the client has experienced. Because abortion may be spontaneous or therapeutic, this number does not necessarily reflect a woman's stance on surgical abortion. In the four-digit number, the fourth number indicates the number of living children, which is 2. In the four-digit number, the first digit indicates the number of term infants born, which is 2. In the four-digit number, the second digit indicates the number of preterm births, so the client has had no preterm births.)

The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching? a. During pregnancy, consumption of oily fish should be avoided. b. Dietary protein can only be obtained through consuming dairy, meat, and eggs. c. Nutritional iodine requirements generally can be met through intake of iodized salt. d. Iron absorption is generally higher for vegetable products than for animal products.

c (Oily fish provide the best source of docosahexaenoic acid (DHA), which may reduce the risk of preterm birth, preeclampsia, low birth weight, and enhance fetal and infant brain development. Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. Intake of iodized salt generally provides the recommended intake of iodine. Iron absorption is generally higher for animal products than for vegetable products.)

The prenatal clinic nurse has received four phone calls. Which client should be called back first? a. Multipara at 11 weeks with untreated hyperthyroidism describing the onset of vaginal bleeding b. Multipara at 6 weeks with a seizure disorder inquiring what foods are good sources of folic acid c. Primipara at 28 weeks with a history of asthma reporting difficulty breathing and shortness of breath d. Primipara at 35 weeks with a positive hepatitis B surface antigen (HBsAG) wondering what treatment her baby will receive after birth

c (Pregnant women with untreated hyperthyroidism have an increased risk of fetal loss. Vaginal bleeding at 11 weeks could indicate that spontaneous abortion is taking place. But the majority of spontaneous abortions prior to 12 weeks' gestation are complete and without complications. This client is not experiencing a normal pregnancy, but the health of both mother and fetus are not in immediate danger. Women with seizure disorders should be started on folic acid supplements prior to pregnancy, and should continue throughout pregnancy. This client is not the highest priority. Asthma exacerbations are most common between 24 and 36 weeks. Asthma attacks can lead to maternal hypoxia, which can lead to fetal hypoxia. This client is the top priority. A client with a positive HBsAG is contagious for hepatitis B. The risk of transmission to the fetus at birth is reduced by bathing the neonate as soon as possible after birth and giving the infant immunoprophylaxis and the first HBsAG vaccine dose. The client seeking information about what will happen after delivery is a low priority when there are pregnant clients currently experiencing physiologic problems.)

The nurse is working in a teen pregnancy clinic. In order to give the pregnant adolescent a role in her prenatal care, what should the nurse encourage the teen to do? a. Choose the schedule of her prenatal visits b. Decide if she wants her labor to be induced c. Measure and record her weight at each visit d. Choose the type of prenatal vitamin she takes

c (Prenatal visit schedules are set to detect developing complications of pregnancy. Induction of labor is a medical decision and should not be taken lightly. Having the client weigh herself and record her weight provides her with information that indicates she is growing a healthy fetus. Prenatal vitamins are prescribed by the certified nurse-midwife or the physician. Many formulations exist, and some might not be indicated for this client due to her nutritional practices and lab results. In addition, if the client is a member of a health maintenance organization, only certain medications (including prenatal vitamins) are accepted for coverage.)

The client has delivered her first child at 39 weeks. How should the nurse document this type of delivery? a. Preterm b. Postterm c. Full Term d. Near term

c (Preterm deliveries are those that occur prior to 36 completed weeks' gestation. Postterm applies to births that occur after 42 weeks' gestation. Full-term births occur between 39 weeks 0 days and 40 weeks 6 days. Near term is not terminology used to describe birth.)

A client who is at 32 weeks' gestation is determined to be at high risk for ABO incompatibility. Which intervention should the nurse anticipate implementing? a. Intramuscular administration of 300 mcg of Rh immune globulin (RhoGAM). b. Obtain an antibody screen (indirect Coombs test) to determine whether the client has developed isoimmunity. c. Note the potential for ABO incompatibility and plan to carefully assess the neonate for the development of hyperbilirubinemia. d. Notify the primary care provider and document the potential need for treatment of fetal hemolytic anemia in the baby after delivery.

c (RhoGAM is administered to prevent sensitization after exposure to Rh-positive blood. An antibody screen (indirect Coombs test) is done to determine whether an Rh-negative woman is sensitized (has developed isoimmunity) to the Rh antigen. Unlike the situation with Rh incompatibility, antepartum treatment of ABO incompatibility is not warranted because it does not cause severe anemia. As part of the initial assessment, however, the nurse should note whether the potential for an ABO incompatibility exists in order to alert healthcare providers to the need for carefully assessing the newborn for the development of hyperbilirubinemia. Unlike the situation with Rh incompatibility, antepartum treatment of ABO incompatibility is not warranted because it does not cause severe anemia.)

A 32-year-old primipara who is at 8 weeks' gestation asks if she should expect any breathing changes as the pregnancy progresses. How should the nurse respond? a. "By the third trimester, you will no longer feel as though you're short of breath." b. "You may experience shortness of breath due to stretching of the round ligament." c. "If you develop shortness of breath, it should improve in the last few weeks of your pregnancy, as lightening occurs." d. "Shortness of breath is an abnormal finding during any stage of pregnancy, and it is considered a serious complication."

c (Shortness of breath occurs as the uterus rises into the abdomen and causes pressure on the diaphragm. This problem worsens in the last trimester. Round ligament stretching causes a "grabbing" sensation in the lower abdomen and inguinal area. The primigravida experiences considerable relief from shortness of breath in the last few weeks of pregnancy, when lightening occurs and the fetus and uterus move down in the pelvis. Because of decreased vital capacity from pressure of the enlarging uterus on the diaphragm, shortness of breath is a common problem of pregnancy.)

A client in the third trimester of pregnancy reports working 8 hours a day as a cashier and stands when at work. What response by the nurse is the most appropriate? a. "No problem. Your baby will be fine." b. "Do you get regular breaks for eating?" c. "Your risk of preterm labor is higher." d. "Standing might increase ankle swelling."

c (Standing more than 5 hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. Although breaks for eating, drinking, and toileting are important for pregnant employees, it is more important to tell the client about the increased risk of preterm labor. Pregnant women who stand for more than 3 hours a day have an increased risk of preterm labor. Because preterm labor can put the infant's life at risk, this statement would be the highest priority. Although this is true, it is less important than teaching the client about the risks of preterm labor when standing more than 3 hours a day.)

While auscultating fetal heart tones, a client who is at 37 weeks' gestation and is in the supine position is experiencing dizziness, lightheadedness, and clammy skin. Which nursing action is the most appropriate? a. Administer supplemental oxygen. b. Help the client turn onto her right side. c. Place a wedge beneath the client's right hip. d. Prepare for administration of packed red blood cells (PRBCs).

c (Supplemental oxygen is not required for supine hypotension syndrome. Positioning the client on her right side would likely exacerbate the reduction in right atrial blood flow. The client is verbalizing symptoms consistent with supine hypotension syndrome, in which compression of the vena cava by the uterus reduces right atrial blood flow. Signs and symptoms include decreased blood pressure, dizziness, pallor, and clamminess. Appropriate interventions include having the woman lie on her left side, or placing a pillow or wedge under her right hip as she lies in a supine position. Packed red blood cell infusion is not required to treat supine hypotension syndrome.)

When preparing nutritional instruction, which pregnant client should the nurse consider the highest priority? a 40-year-old gravida 2 b. 35-year-old gravida 4 c. 15-year-old nulligravida d. 22-year-old primigravida

c (The 40-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. The 35-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. Adolescent clients typically are still in their own growth cycle. Suddenly, they have to supply nutrition for themselves and the fetus. This places them at greatest risk for malnutrition. The 22-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus.)

The nurse receives the following report on a client who delivered 36 hours ago: para 1, rubella immune, A-negative, antibody screen negative, newborn B-positive, Coombs negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse? a. Administer rubella vaccine. b. Ask if she is breast- or bottlefeeding. c. Determine if RhoGAM has been given. d. Discuss the discharge education with the client.

c (The client is rubella immune and does not need the rubella vaccine. This is important but is not the top priority. The client is A-negative and the newborn B-positive. The client needs RhoGAM prior to discharge. Without RhoGAM, the client will make antibodies against Rh-positive blood, and future pregnancies would be in jeopardy. Discharge education is always important, but in this case it is not the most important action.)

The nurse is comparing several different families' developmental stages. What serves as a marker for a family's developmental stage according to Duvall? a. The father's age b. The mother's age c. The oldest child's age d. The youngest child's age

c (The father's age is not a marker, according to Duvall. The mother's age is not a marker, according to Duvall. The oldest child's age serves as a marker for the family's developmental stage, except in the last two stages, when children are no longer present. The youngest child's age is not a marker, according to Duvall.)

A 20-weeks'-gestation adolescent states that it is important not to have a baby that weighs too much and has been limiting her calories so that her current weight has dropped from 110 pounds to 106 pounds. How should the nurse respond? a. "You are causing harm to your baby." b. "You shouldn't be worrying about your figure." c. "Your baby needs adequate nutrition to develop." d. "It's okay to want a small baby when you're a teen."

c (The first role of the nurse is to explain why food is important to the growing fetus, specifying how each food group will help the fetus develop. Next, the nurse must assist the pregnant adolescent to plan foods that she likes to eat from each food group. Pregnant adolescents are just adapting to a new body image created by the changes of puberty when the pregnancy produces rapid and substantial body changes. The desire to maintain a socially desirable figure can lead to nutritional deficits. Teens might not understand the physiology behind the profound body changes of pregnancy. Anticipatory guidance in the body changes of pregnancy will assist the adolescent's adjustment to them. Although many teens are anxious, this teen is expressing a direct nutritional deficit.)

At 32 weeks' gestation, a woman is scheduled for a second non-stress test. Which client response indicates an adequate understanding of this procedure? a. "I'll have an IV started before the test." b. "I need to have a full bladder for this test." c. "I cannot get up and walk around during the test." d. "I must avoid drinks containing caffeine for 24 hours before the test."

c (There is no IV needed to administer medications. Clients usually are asked to have their bladders full only for ultrasounds. The purpose of the non-stress test is to determine the results of movement on fetal heart rate. The client will have to lie still on her side during the procedure. Caffeine might cause the infant to be more active and cause the test to go more quickly.)

A client at 9 weeks' gestation learns about being HIV positive. Which client statement indicates teaching about the effects on the baby has been effective? a. "The pregnancy will increase the progression of my disease and will reduce my CD4 counts." b. "The HIV will not affect my baby, and I will have a low-risk pregnancy without additional testing." c. "My baby will probably be born with anti-HIV antibodies, but that does not mean the baby is infected." d. "I cannot take the medications that control HIV during my pregnancy because they will harm the baby."

c (There is no evidence to indicate that pregnancy increases the progression of HIV/AIDS. Pregnancy affected by HIV/AIDS is considered complicated, and the fetus is monitored closely. Fetal assessments include weekly non-stress tests beginning at 32 weeks. Babies of HIV-positive women or women with AIDS are born with maternal anti-HIV antibodies. HIV infection in infants should be diagnosed using HIV virologic assays as soon as possible, with initiation of infant antiretroviral prophylaxis immediately if the test is positive. Most of the medications that control HIV progression are safe to take during pregnancy. Antiretroviral medications are recommended during pregnancy to prevent perinatal transmission.)

Which maternal-child client should the nurse see first? a. Blood type B, Rh-positive b. Blood type O, Rh-negative c. Direct Coombs test positive d. Indirect Coombs test negative

c (This client's blood type creates no problems. This client is Rh-negative, but there is no indication that the alloimmunization has occurred. A direct Coombs test looks for Rh antibodies in the fetal blood circulation. A positive result indicates that that there is an Rh incompatibility between mother and infant, and the baby is making anti-Rh antibodies, which in turn leads to hemolysis. This infant is at risk for anemia and hyperbilirubinemia. An indirect Coombs test looks for Rh antibodies in the maternal serum; a negative result indicates the client has not been alloimmunized.)

The nurse is preparing materials for couples beginning prenatal care. What information is most important for the nurse to include? a. The birthing unit was remodeled and redecorated last year. b. Some of the healthcare providers recommend circumcision for baby boys. c. There are various types of healthcare providers to support the client through the process. d. There are different types of rooms for giving birth, each with different equipment.

c (This information does not help clients understand their options or make decisions. Because not all clients will be having boys, this statement is only helpful to those clients who give birth to males and see a healthcare provider who recommends circumcision. This statement is too narrowly focused to be helpful to all clients. This statement is the most important. The nurse should inform clients what their options are, including the types of healthcare providers available. This statement is too vague to facilitate decision making by the couple.)

A pregnant client at 23 weeks' gestation has a hemoglobin of 9.5. Which diet choice indicates that teaching has been effective? a. Broiled fish, lettuce salad, grapefruit half, carrot sticks b. Pork chop, mashed potatoes and gravy, cauliflower, tea c. Roast beef, steamed spinach, tomato soup, orange juice d. Tofu with mixed vegetables in curry, milk, whole-wheat bun

c (This meal is high in fiber, low in fat, and moderately high in protein, but low in iron. This client is anemic and needs iron. This meal has a moderate amount of protein, but no vitamin C. The meal containing beef is better. This client is anemic and needs iron. This meal contains iron in the beef, folic acid in the spinach, and vitamin C in the tomato soup and orange juice. Vitamin C helps absorption of the iron; folic acid is needed for production of red cells. This diet is high in calcium. The client has iron-deficiency anemia and requires a high-iron diet.)

Which statement is best to include when teaching a pregnant adolescent about nutritional needs? a. "You just need to pay attention to what you eat now." b. "Folic acid intake is the key to having a healthy baby." c. "It is important eat iron-rich foods like meat every day." d. "Calcium and milk aren't needed until the third trimester."

c (This response is too vague to be helpful. Adolescents will need specific information to improve nutrition during pregnancy. Although folic acid is important during pregnancy to prevent neural tube defects, and for lactation, there is not one single nutritional element responsible for having a healthy baby. Adolescents often have an iron intake that is inadequate for pregnancy. Giving specific examples is most helpful when providing nutritional information. Calcium is needed throughout pregnancy and should be consumed daily.)

The nurse is reviewing nursing documentation related to the care of a client who had an amniocentesis. Which nursing note reflects appropriate client care? a. Prior to discharge, the client demonstrated vaginal spotting. b. An Rh-positive client received RhoGAM after the amniocentesis. c. The client was monitored for 30 minutes after completion of the test. d. The client reported that she takes insulin before each meal and at bedtime.

c (Vaginal spotting after the amniocentesis is not an expected finding. A client experiencing vaginal bleeding of any amount after amniocentesis requires additional assessment and should not be sent home. Only Rh-negative clients receive RhoGAM after amniocentesis. The Rh-positive client should not ever receive RhoGAM. Twenty to 30 minutes of fetal monitoring is performed to assess for fetal well-being and to rule out injury of the fetus or placenta during the examination. Whether or not a client takes insulin has nothing to do with amniocentesis. This answer does not relate to the question asked.)

A pregnant client at 14 weeks' gestation is diagnosed with hyperemesis gravidarum. The most recent vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first? a. Weigh the client. b. Encourage clear liquids orally. c. Give 1 L of lactated Ringer solution IV. d. Administer 30 mL Maalox (magnesium hydroxide) orally.

c (Weighing the client provides information on weight gain or loss, but it is not the top priority in a client with excessive vomiting during pregnancy. The vital signs indicate hypovolemia. The client needs IV fluids. The client needs IV fluids because of the vital signs indicating hypovolemia. Oral fluids are not likely to be tolerated well by a client with hyperemesis. Lack of tolerance of oral fluids through excessive vomiting is what has led to the hypovolemia. The vital signs indicate hypovolemia. Giving this client a liter of lactated Ringer solution intravenously will reestablish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down. The vital signs indicate hypovolemia. There is no indication that the client has dyspepsia. The client needs IV fluids.)

A 23-year-old client who is at 10 weeks' gestation with a first pregnancy expresses worry over feeling no sexual desire for her spouse and asks if this is normal. How should the nurse respond? a. "That's unusual. Throughout a healthy pregnancy, sexual desire usually increases with each trimester." b. "That's unusual. Usually, there are minimal changes in sexual desire throughout a healthy pregnancy." c. "That sounds normal. In many cases, sexual desire decreases in the first trimester, but it increases again during the second trimester." d. "That sounds normal. During the first trimester, sexual desire often decreases; however, by the third trimester, sexual desire is usually greater than before pregnancy."

c (While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester. During the first trimester, factors such as fatigue, nausea, vomiting, and breast tenderness may decrease desire for sexual activity. During the second trimester, as these discomforts lessen and pelvic vascular congestion increases, the woman may experience greater sexual satisfaction than before pregnancy. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester.)

After completing a physical assessment the nurse determines that a laboring client is experiencing a panic attack. What findings did the nurse use to make this clinical determination? Select all that apply. a. Flat affect b. Monotone replies c. Heart rate 120 bpm d. Respiratory rate 28/minute e. Disoriented to place and time

c and d (A flat affect would be associated with depression. Monotone replies are associated with depression. A heart rate of 120 bpm indicates tachycardia, a manifestation of a panic attack. A respiratory rate of 28/minute indicates hyperventilation, a manifestation of a panic attack. Disorientation to place and time would be associated with schizophrenia.)

The nurse is preparing an educational program on the different types of pregnancy tests. What should the nurse include about the β-subunit radioimmunoassay (RIA) test? Select all that apply. a. It causes a color change. b. It takes 2 to 3 hours to perform. c. It is able to detect trophoblastic disease. d. It is able to detect an ectopic pregnancy. e. It is the same as an over-the-counter test.

c and d (Enzyme-linked immunosorbent assay (ELISA) uses a substance that results in a color change after binding. Fluoroimmunoassay (FIA) takes about 2 to 3 hours to perform. β-Subunit radioimmunoassay (RIA) uses an antiserum with specificity for the β-subunit of hCG in blood plasma. This test may not only detect pregnancy but also detect trophoblastic disease. β-Subunit radioimmunoassay (RIA) uses an antiserum with specificity for the β-subunit of hCG in blood plasma. This test may not only detect pregnancy but also detect an ectopic pregnancy. Over-the-counter pregnancy tests are ELISA tests. This assay, which may be done on urine or blood, is sensitive and quick. It can detect hCG levels as early as 7 to 9 days after ovulation and conception, which is 5 days before the first missed period.)

A pregnant client wants natural childbirth and asks what approaches can be used to keep the mind and body relaxed during labor. Which mind-based therapies should the nurse review with this client? Select all that apply. a. Qigong b. Massage c. Hypnosis e. Visualization d. Guided imagery

c, d, and e (Qigong is a self-discipline that involves the use of breathing, meditation, self-massage, and movement. It is not considered a mind-based therapy. Massage therapy involves manipulation of the soft tissues of the body to reduce stress and tension, increase circulation, diminish pain, and promote a sense of well-being. It is not considered a mind-based therapy. Hypnosis is a state of great mental and physical relaxation during which a person is very open to suggestions. Pregnant women who receive hypnosis before childbirth have reported shorter, less painful labors and births. Visualization is a complementary therapy in which a person goes into a relaxed state and focuses on, or "visualizes," soothing or positive scenes such as a beach or a mountain glade. Visualization helps reduce stress and encourage relaxation. Guided imagery is a state of intense, focused concentration used to create compelling mental images. It is sometimes considered a form of hypnosis.)

A pregnant client is receiving the results of perinatal testing. Which statement indicates that the client understands the test result? a. "Because my contraction stress test was positive, we know that my baby will tolerate labor well." b. "The reactive non-stress test means that my baby is not growing because of a lack of oxygen." c. "My biophysical profile score of 6 points indicates everything being normal and healthy for my baby." d. "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby."

d (A contraction stress test creates mild contractions. The presence of decelerations is termed a positive result and indicates a lack of adequate placental functioning. The non-stress test utilizes external fetal monitoring to assess the fetal heart rate in relationship to fetal movement. When accelerations in the fetal heart rate are associated with fetal movement (a reactive result), the fetus is well oxygenated, and the placenta is functioning well. The biophysical profile score should be 8 (with adequate amniotic fluid) or 10. A score of 6 is abnormal and indicates that further assessment is needed. The Doppler velocimetry test looks at blood flow through the umbilical artery. A normal result indicates there is no vasospasm decreasing blood flow to the placenta; therefore, the baby is getting an adequate blood supply.)

During a non-stress test, the nurse notes that the fetal heart rate decelerates about 15 beats during a period of fetal movement. The decelerations occur twice during the test and last 20 seconds each. What should the nurse expect the outcome of this test will be? a. A reactive test b. A negative test c. An equivocal test d. A nonreactive test

d (A reactive stress test has the expected results of an increase in heart rate of 15 beats per minute for 15 seconds or more. Non-stress tests are scored as either reactive or nonreactive. Non-stress tests are scored as either reactive or nonreactive. In a nonreactive stress test, the reactivity criteria are not met. Since this client experienced a deceleration during the test, this is considered nonreactive.)

The school sexual health clinic nurse has female adolescent students waiting to be seen. Which student should be seen first? a. 17-year-old adolescent with a history of child abuse b. 14-year-old adolescent whose 17-year-old sister is pregnant c. 15-year-old adolescent who reports using condoms regularly d. 16-year-old adolescent who had a chlamydial infection treated 2 weeks ago

d (Although adolescents with a history of abuse are more likely to become pregnant than are their peers who have not experienced abuse, too little information is given about this client to determine risk for pregnancy. This client is not the top priority. Although this student is at risk for becoming pregnant because her sister is experiencing an adolescent pregnancy, it is not known whether this client is sexually active. This student is not the top priority. Condom use will decrease the risk of becoming pregnant. This client is a low priority. This client is the top priority. Having had a chlamydial infection, a sexually transmitted infection, indicates that the client is sexually active and not using a barrier method of birth control. This client is at risk for pregnancy and another STI.)

The prenatal clinic nurse is designing a new prenatal intake information form for pregnant clients. Which question is the most important to include on this form? a. What is the name of the baby's father? b. Where was the father of the baby born? c. Are you married to the father of the baby? d. Do genetic diseases run in the family of the baby's father?

d (Although it is helpful for the nurse to know the name of the father's baby to include him in the prenatal care, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited. This is not important information for pregnancy. Although the marital status of the client might have cultural significance, this is psychosocial information and much less important than possible genetic diseases that the baby might have inherited. This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby.)

The nurse learns that a pregnant client's religion is Judaism. Why is this information important? a. Religious and cultural background can impact what a client eats during pregnancy. b. Knowing the client's beliefs and behaviors regarding pregnancy is important. c. Clients sometimes encounter problems in their pregnancies based on what religion they practice. d. It provides a baseline from which to ask questions about the client's religious and cultural background.

d (Although this is true, much more than diet is impacted by religious and cultural background; values, beliefs, expectations for the birth, and acceptance or refusal of medical treatment are also influenced by religious or cultural background. Not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping clients based on their background. The nurse must use the information on the client's background as an educated starting point on which to base further questions about how this specific client enacts her religious or cultural background. How a client enacts her religion occasionally will cause problems with pregnancy. But the most important reason for asking a client for her religious or cultural background is to have a starting point on which to base further questions on the specifics of how this client is impacted by or enacts her cultural or religious background as a unique individual. This is the best explanation because not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping clients. Thus, the nurse should use the information on the client's background as an educated starting point on which to base further questions about how this specific client enacts her religious or cultural background.)

An adolescent client reports that her period is late but that her home pregnancy test is negative. Which response is most appropriate? a. "This means you are not pregnant." b. "We do not trust home tests. Come to the clinic for a blood test." c. "Most people do not use the tests correctly. Did you read the instructions?" d. "You might be pregnant, but it might be too early for your home test to be accurate."

d (Although this might be true, this is not the best response because the pregnancy may not yet be detectable through use of a urine pregnancy test. This statement is not therapeutically worded. Additionally, this statement is not true because home pregnancy tests are quite simple to use and quite accurate. A clinic pregnancy test is usually a urine test. Blood tests are more invasive and more expensive. This response does not address the issues presented in the client's statement. This is an accurate and appropriate response. Most home pregnancy tests have low false- positive rates, but the false-negative rate is slightly higher. Repeating the test in 1 week is recommended.)

The nurse is working with male teens whose partners are pregnant. Which situation with a father-to-be requires nursing intervention? a. The pregnancy does not seem real to him, and he is not sure what he should do to plan for the future. b. Because his father was not involved in his life, he wants to be actively involved in the life of his child. c. He is not convinced that he is the father of the baby and does not want his name on the birth certificate. d. He is the only other person who will be present, although his girlfriend wants her mother to be with her during the birth.

d (An early pregnancy is often an abstract concept to fathers. It is normal for a teen to be unsure about the future. This might be the case when a young father was raised without his own father, or a lack of involvement with the child might be seen as the norm and desired. Many young fathers are not sure if they are the father of the baby and do not want to be listed on the birth certificate if they are not sure. Often these young men will request paternity testing to either verify or discount their parentage. It is common for pregnant adolescents to want their mothers to accompany them for the labor and birth. Overriding his girlfriend's expressed desire could be an indication that their relationship is abusive.)

The nurse is performing a family assessment. What type of family should the nurse identify when both parents work? a. An extended family b. An extended kin family c. A traditional nuclear family d. A dual-career/dual-earner family

d (An extended family is defined as couples who share household and childrearing responsibilities with parents, siblings, or other relatives. An extended kin family is a specific form of an extended family. The traditional nuclear family is defined as a husband/provider, a wife who stays home, and children. A dual-career/dual-earner family is characterized by both parents working, by either choice or necessity.)

The home health nurse visits the home of a Korean couple to follow up on their jaundiced 4-day-old baby. Considering family structure, what family members might the nurse expect to see in the home? a. The godparents b. Just the parents c. The grandmother d. The grandfather and parents

d (Asians traditionally revere their elders and their wisdom. The godparents would not have the last word in decision making for this family. Asians traditionally revere their elders and their wisdom. The parents would not have the last word in decision making for this family. Asians traditionally revere their elders and their wisdom. The grandmother would not have the last word in decision making for this family. The grandfather is the family member who plays a key role in decision making and who is likely to be present in this situation. Asians traditionally revere their elders and their wisdom.)

The spouse accompanies a pregnant client to a prenatal visit. Which question should the nurse use to determine the amount of anticipatory guidance the spouse will need? a. "What kind of work do you do?" b. "How moody has your wife been lately?" c. "What furniture have you gotten for the baby?" d. "How are you feeling about becoming a father?"

d (Asking about vocation does not help determine the amount of anticipatory guidance the spouse will need. Asking about the client's mood does not help determine the amount of anticipatory guidance the spouse will need. Buying furniture does not help determine the amount of anticipatory guidance the spouse will need. Anticipatory guidance of the expectant father is a necessary part of any plan of care. He may need information on a variety of topics about the pregnancy, and the best question to learn the spouse's needs is to ask about his feelings about becoming a father.)

The nurse explains to a pregnant woman that her antepartum assessment will include assessment of clinical pelvimetry. Which client response reflects understanding of the reason for this test? a. "It will help me understand how big a baby I can have." b. "It will be used to screen for gestational diabetes." c. "It will be used to find out whether my baby has a chromosomal abnormality." d. "It will help tell whether my pelvis is big enough to deliver my baby vaginally."

d (Clinical pelvimetry is performed to estimate the adequacy of pelvic size for the purpose of vaginal delivery; delivery of larger infants may be accommodated via cesarean section. Screening for maternal gestational diabetes requires some form of glucose screening. Clinical pelvimetry involves estimating the adequacy of pelvic size for facilitating vaginal birth. Clinical pelvimetry is performed to estimate the ease or difficulty associated with vaginal delivery of an infant.)

A 20-year-old woman at 28 weeks' gestation has a history of past drug abuse and her urine screening indicates recent heroin use. What should the nurse recognize this client is at risk for developing? a. Diabetes mellitus b. Abruptio placentae c. Erythroblastosis fetalis d. Pregnancy-induced hypertension

d (Diabetes is an endocrine disorder that is unrelated to drug use/abuse. Abruptio placentae is seen more commonly with cocaine/crack use. Erythroblastosis fetalis is secondary to physiologic blood disorders such as Rh incompatibility. Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or preeclampsia).)

A pregnant 14-year-old client confides having problems with bulimia nervosa. Which nursing observation best supports the client's statement? a. The client reports dietary cravings for soil and clay. b. In terms of food variety and quantity, the client's diet is extremely restrictive. c. Despite being extremely underweight, the client describes herself as being fat. d. The client is of normal weight for her height and reports binge eating followed by purging.

d (Dietary cravings for and consumption of nonnutritive substances is consistent with pica. The dietary intake of individuals with anorexia nervosa is very restrictive in both variety and quantity. Anorexia nervosa is an eating disorder characterized by an extreme fear of weight gain and becoming fat, and it incorporates a self-perception of being overweight even when the individual is extremely underweight. Bulimia is characterized by binge eating and purging, and individuals with bulimia nervosa often maintain normal or near-normal weight for their height.)

A woman of Korean descent has just given birth to a son. Her partner wishes to give her sips of hot broth from a thermos they brought with them. They have refused your offer of ice chips or other cold drinks for the client. What should the nurse do? a. Explain to the client that she can have the broth if she will also drink cold water or juice. b. Encourage the client to have the broth, after the nurse takes it to the kitchen and boils it first. c. Explain to the couple that food is not allowed to be brought from home, but that the nurse will make hot broth for them. d. Encourage the partner to feed the client sips of their broth. Ask if the client would like you to bring her some warm water to drink as well.

d (Explaining to the client that she can have broth if she will drink cold water or juice first does not show cultural sensitivity and does not respect the client's beliefs. Encouraging the client to have broth after you take it to the kitchen and boil it first does not demonstrate cultural sensitivity. Explaining to the couple that food is not allowed to be brought from home but that you will make hot broth for them does not demonstrate cultural sensitivity. Encouraging the partner to feed the client sips of their broth and asking if the client would like you to bring her some warm water to drink are approaches that show cultural sensitivity. The equilibrium model of health, based on the concept of balance between light and dark, heat and cold, is the foundation for this belief and practice.)

A pregnant client who uses cocaine and ecstasy on a regular basis asks why ecstasy should not be used during pregnancy. What should the nurse explain about this drug? a. "It produces intrauterine growth restriction and meconium aspiration." b. "It leads to deficiencies of thiamine and folic acid, which help the baby develop." c. "It produces babies with small heads and short bodies with brain function alterations." d. "It can cause a high fever in you if high doses are taken and therefore cause the baby harm."

d (Heroin causes these fetal effects, not ecstasy. Alcohol, not ecstasy, causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine causes these fetal effects, not ecstasy. High body temperature is a side effect of MDMA (methylenedioxymethamphetamine: ecstasy). Increased body temperature increases fetal oxygen needs, which can lead to hypoxia and subsequent brain and major organ damage.)

A client who is at 18 weeks' gestation has been newly diagnosed with megaloblastic anemia. Which client statement indicates teaching has been effective? a. "My body makes red blood cells that are smaller than they should be." b. "Megaloblastic anemia is not known to cause any serious risks to my baby." c. "Whenever possible, I should boil my vegetables in at least 2 quarts of water." d. "I should include fresh leafy green vegetables, red meat, fish, poultry, and legumes in my diet."

d (In megaloblastic anemia, red blood cells become enlarged and are fewer in number. Maternal folic acid deficiency has been associated with an increased risk of neural tube defects (NTDs) such as spina bifida, meningomyelocele, and anencephaly in the newborn. Folic acid, which is crucial for inclusion in the diet of clients with megaloblastic anemia, is easily destroyed by overcooking or cooking with large quantities of water. Folic acid, which is used to treat megaloblastic anemia, is readily available in foods such as fresh leafy green vegetables, red meat, fish, poultry, and legumes.)

A 15-year-old primipara at 8 weeks' gestation who is 64 inches tall and weighs 115 pounds asks why she is supposed to gain so much weight. What is the best response by the nurse? a. "Inadequate weight gain delays lactation after delivery." b. "It's what your certified nurse-midwife recommended for you." c. "Weight gain is important to assure that you get enough vitamins." d. "Gaining 25 to 35 pounds is recommended for healthy fetal growth."

d (Inadequate weight gain can lead to decreased fetal growth and development. Although this statement might be true, the client has asked a "why" question that should be directly answered. Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet is probably not optimal, and her intake of empty calories or junk food might make up the majority of her caloric intake. Adolescents who become pregnant less than 4 years after menarche are at risk because of their physiologic and anatomic immaturity. They are more likely than older adolescents to still be growing, which can affect the fetus's development.)

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which client statement indicates that teaching has been effective? a. "A beer once a week will not damage the fetus." b. "I can continue to drink alcohol until I am diagnosed as being pregnant." c. "I can drink alcohol while breastfeeding since it does not pass into breast milk." d. "I need to stop drinking alcohol completely when I start trying to get pregnant."

d (It is not known how much alcohol will cause fetal damage; therefore, alcohol during pregnancy is contraindicated. Women should discontinue drinking alcohol when they start to attempt pregnancy. Breastfeeding generally is not contraindicated, although alcohol is excreted in breast milk. Excessive alcohol consumption may intoxicate the infant and inhibit the maternal letdown reflex. Because birth defects that are related to fetal alcohol exposure can occur in the first 3 to 8 weeks' gestation, often before the woman even knows she is pregnant, women should discontinue drinking alcohol when they start to attempt pregnancy.)

The nurse is caring for a pregnant teen. What should the nurse do to accurately assess the teen's nutritional intake? a. Assess laboratory values. b. Ask about cooking facilities. c. Observe for clinical signs of malnutrition. d. Ask to complete a dietary recall to identify eating patterns.

d (Laboratory values only provide information about the nutritional status of the client. Cooking facilities might not be related to food intake. Clinical signs of malnutrition only provide information about the nutritional status of the client. In assessing the diet of the pregnant adolescent, it is important to consider the eating pattern over time, not simply a single day's intake. Once the pattern is identified, counseling can be directed toward correcting deficiencies.)

Being aware that several pregnant students have been diagnosed with iron-deficiency anemia, the school nurse plans a class about nutrition for pregnant teens. What should the nurse encourage the teens to consume to increase iron absorption? a. Milk b. Green tea c. Gatorade d. Orange juice

d (Milk does not contain vitamin C. Green tea does not contain vitamin C. Gatorade does not contain vitamin C. Vitamin C is found in citrus fruits and juices and is known to enhance the absorption of iron from meat and nonmeat sources.)

A 28-year-old client who is pregnant with her first child reports increased dental caries (cavities) since becoming pregnant. How should the nurse explain the likely cause for this change? a. "Each woman experiences changes that affect her teeth while she's pregnant." b. "When a woman is pregnant, her teeth lose calcium and she is more susceptible to getting cavities." c. "During pregnancy, tooth enamel softens and the woman is more susceptible to getting cavities." d. "It may be necessary to pay extra attention to dental care while you're pregnant, especially if you're vomiting frequently."

d (No demonstrable changes occur in the teeth of pregnant women. Calcium is not lost from the teeth during pregnancy. Tooth enamel does not soften during pregnancy. The dental caries that sometimes accompany pregnancy are probably caused by inadequate oral hygiene and dental care, especially if the woman has problems with bleeding gums or nausea and vomiting.)

Upon arriving at the prenatal clinic in the morning, the nurse receives messages from four clients. Which client complaint should be addressed first? a. Primipara at 24 weeks' gestation with ankle edema b. Multipara at 35 weeks' gestation with new onset of hemorrhoids c. Primipara at 9 weeks' gestation with increased fatigue and nocturia d. Multipara at 30 weeks' gestation with vaginal bleeding after performing yoga

d (Particularly during the second and third trimesters, ankle edema is a common pregnancy-related discomfort. Hemorrhoids are a common pregnancy-related discomfort, especially during the second and third trimesters. Fatigue and increased urination at night is a common pregnancy-related discomfort during the first trimester. Vaginal bleeding after yoga is a warning sign that should be immediately reported to the healthcare provider; this client is the highest priority for care.)

A pregnant client who is a lacto-ovo vegetarian asks for help planning a diet that includes adequate protein intake. What instruction should the nurse give? a. "To improve protein absorption, avoid simultaneous intake of animal protein and plant protein." b. "Following a lacto-ovo vegetarian diet will require you to take a daily supplement of vitamin B12." c. "Because you don't eat meat, eggs, or dairy products, it's important to eat adequate plant-based proteins." d. "In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins."

d (Plant protein quality can be improved if it is consumed with certain animal proteins. Vegan diets, in which no animal products are consumed, often require daily supplementation of vitamin B12. While lacto-ovo vegetarians do not eat meat, they do eat eggs, milk, and dairy products. A diet that includes plant proteins, such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk, helps ensure the expectant mother obtains all the essential amino acids.)

The nurse is working with a group of pregnant teens. Which statement indicates that teaching has been successful? a. "My baby could come late because I am a teenager." b. "Because I am young, I have a low risk for preeclampsia." c. "I am more likely to use birth control after I have this baby." d. "Pregnant teens are more likely to quit school prior to graduation."

d (Postdates are not a risk for adolescent pregnancy; preterm birth and small-for-gestational-age infants are risks for pregnant teens. Preeclampsia is more likely to occur in teen mothers than in mothers older than age 19. Clients who give birth the first time as adolescents are more likely to have their next child during adolescence as well. Birth control use is not higher among teen parents. Clients who give birth the first time as adolescents are more likely to have lower educational levels, including a higher rate of dropping out of high school and not attending college or vocational training.)

Which statement, if made by a pregnant adolescent, indicates that she understands her increased risk of physiologic complications during pregnancy? a. "Smoking and using crack cocaine won't harm my baby." b. "My anemia and eating mostly fast food are not important." c. "It's no big deal that I started prenatal care in my seventh month." d. "I need to take good care of myself so my baby doesn't come early."

d (Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Pregnant adolescents are at great risk for complications such as anemia. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus.)

A pregnant couple would like their 5-year-old to attend the birth. Which should the nurse say in response to this couple's plan? a. "Bring some toys to keep your child occupied." b. "Children under 12 are not allowed to be present at the birth." c. "You should let your child stay home because you will be focusing on the birth." d. "You should bring someone who will only tend to any specific needs of your child."

d (Preparing the child on what to expect is beneficial. Toys will not sustain a 5-year-old's attention for an extended time period. Children are allowed to be present at births. A sibling should have his own support person whose primary responsibility is to take care of the child's needs so that the child will have support if anxiety develops over the birth process, and the mother can concentrate on the labor and birth. A sibling should have his own support person whose primary responsibility is to take care of the child's needs so that the child will have support if anxiety develops over the birth process, and the mother can concentrate on the labor and birth.)

The nurse instructs a client on the importance of reducing exposure to infections while pregnant. Which client statement indicates that teaching has been effective? a. "My genital herpes infection will have no effect on my baby." b. "Because I have toxoplasmosis, my baby might be born with an abnormally long body." c. "The rubella infection I experienced in my second trimester may lead me to become deaf." d. "My baby may develop a serious blood infection because I have group B strep in my vagina."

d (Primary herpes simplex infection poses the greatest risk to both the mother and her infant. Primary infection has been associated with spontaneous abortion, low birth weight, and preterm birth. Transmission to the fetus almost always occurs after the membranes rupture and the virus ascends or during birth through an infected birth canal. Toxoplasmosis during pregnancy can cause fetal microcephaly, hydrocephalus, coma, convulsions, or retinochoroiditis. Rubella infection during pregnancy can lead to fetal deafness, congenital heart defects, and developmental delays in the fetus. Maternal deafness is not a risk for perinatal rubella. Group B streptococcus can cause neonatal septicemia or pneumonia unless IV antibiotics are given during labor.)

A postpartum client with blood type A, Rh-negative delivered a newborn with blood type AB, Rh-positive. Which statement indicates that teaching about this blood type inconsistency has been effective? a. "Because my baby is Rh-positive, I do not need RhoGAM." b. "Before my next pregnancy, I will need to have a RhoGAM shot." c. "If my baby had the same blood type I do, it might cause complications." d. "I need to get RhoGAM so I do not have problems with my next pregnancy."

d (Rh-negative mothers who give birth to Rh-positive infants should receive Rh immune globulin (RhoGAM) to prevent alloimmunization. Rh-negative mothers who give birth to Rh-positive infants should receive Rh immune globulin (RhoGAM). The injection must be given within 72 hours after delivery to prevent alloimmunization. It is specifically the Rh factor that causes complications; ABO grouping does not cause alloimmunization. Rh-negative mothers who give birth to Rh-positive infants should receive Rh immune globulin (RhoGAM) to prevent alloimmunization, which could cause fetal anemia and other complications during the next pregnancy.)

A client in labor is a Lebanese immigrant, and she explains that in the Muslim faith, the baby's name is selected after delivery, as it is God's will whether or not the baby will be born. Which nursing response is appropriate? a. "Are you afraid your baby will not live?" b. "We have a very low rate of complications at this facility." c. "In the United States, you can feel free to choose your baby's name prior to the delivery." d. "Thank you for explaining that to me. By sharing your cultural beliefs with me, you are helping me to provide you with the best possible care."

d (The client is describing the application of a culturally based belief, not a concern about complications. It is neither realistic nor appropriate to assume that people of another culture will automatically abandon their ways and adopt the practices of a dominant culture. The identification of cultural values is useful in planning and providing culturally sensitive care.)

A pregnant woman married to an intravenous drug user had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV? a. Elevated blood pressure and ankle edema b. Shortness of breath and frequent urination c. Hemoglobin of 11 g/dL and a rapid weight gain d. Unusual fatigue and recurring Candida vaginitis

d (The client would have a decrease in blood pressure and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV. The client would be anemic and anorexic. The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as Candida vaginitis.)

Which statement by a parent of a pregnant, unmarried 15-year-old is expected? a. "I'm not going to get involved. She understands how her health insurance works." b. "An abortion is the best choice for her. She can deal with our Catholic priest later." c. "We're very happy for her. It will be easier to focus on education with a new baby." d. "Her father told her to stop dating that boy. Now look at the trouble she's gotten into."

d (The parent of a pregnant teen is usually the support person and helps the teen understand how to access prenatal care. It is unlikely that a 15-year-old would understand health insurance. This statement indicates that the parent is not going to discuss the pregnancy with the teen but might be forcing the teen into abortion. Because religious tradition impacts views on abortion, and Catholicism disapproves of abortion, the teen might not accept abortion as an option. Most parents accept the pregnancy but are not excited when their 15-year-old is pregnant. And education is harder when child care is involved. Teens that give birth are less likely to complete their education. This statement indicates anger and dismay, which are expected when a parent finds out about a teen daughter's pregnancy.)

A client with preeclampsia is assessed with the following: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 1+ on dipstick; and edema of the hands, ankles, and feet. Which new assessment finding indicates the client's condition is getting worse? a Reflexes 2+ b. Platelet count 150,000 c. Blood pressure 158/104 d. Urinary output 20 mL/hour

d (The reflexes are normal at 2+. The platelet count is normal, though it is at the lower end. The blood pressure has not had a significant rise. The decrease in urine output is an indication of decrease in glomerular filtration, which indicates a loss of renal perfusion. The assessment finding most abnormal and life threatening is the urine output change.)

The nurse is caring for a client at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital should cause the greatest concern? a. "Blood pressure 110/68, pulse 90." b. "Clear fluid is leaking from the vagina." c. "Client is positioned in a left lateral tilt." d. "Entrance wound present below the umbilicus."

d (These are normal vital signs, indicating a hemodynamically stable client. Clear fluid from the vagina could be amniotic fluid from spontaneous rupture of the membranes. Although this is not a normal finding at 35 weeks, this fetus is near term and would likely survive birth at this time. Positioning the client in a lateral tilt position prevents vena cava syndrome. Penetrating abdominal trauma has a 59% to 80% fetal injury rate. This fetus is at great risk for injury.)

A multigravida gave birth to an 18-week fetus last week. During her follow-up she sees that it is documented in her medical record that she had one abortion and becomes upset over the use of this word. How can the nurse best explain this terminology to the client? a. "Abortion is what we call all babies who are stillborn." b. "Abortion is the word we use when someone has miscarried." c. "Abortion is how we label pregnancies that end in the second trimester." d. "Abortion is the medical term for all pregnancies that end before 28 weeks."

d (Third-trimester losses are considered fetal death in utero, and the term abortion is not used. Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Abortions are fetal losses prior to the onset of the third trimester and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages.)

A pregnant client who swims 3 to 5 times per week asks the nurse if she should stop this activity. What is the appropriate nursing response? a. "You should discontinue your exercise program immediately." b. "You should increase the number of times you swim per week." c. "You should decrease the number of times you swim per week." d. "You should continue your exercise program because it would be beneficial."

d (Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. There is no reason for the exercise to be discontinued. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women. There is no reason for the exercise to be increased. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women. There is no reason for the exercise to be decreased. Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.)

The nurse is seeing prenatal clients in the clinic. Which client is exhibiting expected findings? a. Primipara at 26 weeks with fundal height of 30 cm b. Multipara at 12 weeks who reports bright red vaginal bleeding c. Multipara at 22 weeks who reports no fetal movement felt yet d. Primipara at 12 weeks with fetal heart tones heard by Doppler fetoscope

d (This is an abnormal finding. Beginning in the second trimester, the fundal height should correlate with weeks of gestation; thus, at 26 weeks' gestation, the fundal height should be about 26 cm. This is an abnormal finding. Bright red bleeding during pregnancy is never expected. This is an abnormal finding. Fetal movement should be felt by 20 weeks. This is an expected finding because fetal heart tones should be heard by 12 weeks using an ultrasonic Doppler fetoscope.)

The charge nurse is reviewing the healthcare plans written by the unit's staff nurses. Which NANDA nursing diagnosis is most likely to be construed as culturally biased and possibly offensive? a. Fear related to separation from support system during hospitalization b. Spiritual Distress related to discrepancy between beliefs and prescribed treatment c. Interrupted Family Processes related to a shift in family roles secondary to demands of illness d. Noncompliance related to impaired verbal communication secondary to recent immigration from non-English-speaking area

d (This option seeks to explain how the culturally sensitive nurse can partner with the families more effectively. This option seeks to explain how the culturally sensitive nurse can partner with the families more effectively. This option seeks to explain how the culturally sensitive nurse can partner with the families more effectively. The phrase "impaired verbal communication" might be offensive because speaking a different language is not equivalent to being impaired, and noncompliance does not stem from misunderstanding.)

The client with insulin-dependent type 2 diabetes and an HbA1c of 5% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client? a. Vascular disease that accompanies diabetes slows progression. b. The risk of ketoacidosis decreases during the length of the pregnancy. c. The baby is likely to have a congenital abnormality because of the diabetes. d. Insulin needs decrease in the first trimester and increase during the third trimester.

d (Vascular disease progresses more rapidly during pregnancy, especially if blood sugar control is not good. Problems such as nephropathy and retinopathy can result. The risk of ketoacidosis increases during pregnancy. Infants of diabetic mothers have a 5% to 10% greater risk of having a congenital abnormality. This risk increases to 20% to 25% if the HbA1c is over 10%. In addition, insulin requirements drop suddenly after delivery of the placenta.)

The nurse is planning an educational session for pregnant clients who are vegans. What information should the nurse include? a. Vegan diets are high in iron. b. Rice contains a high level of vitamin B12. c. Soy is not a good source of protein for vegans. d. Eating beans and rice provides complete protein needs.

d (Vegan diets are low in iron, and pregnant vegans often experience anemia. Rice does not contain vitamin B12. Soy is a very good source of protein and calcium and is safe during pregnancy. Complete proteins can be obtained by eating different types of plant-based proteins such as beans and rice.)

A 28-year-old woman at 16 weeks' gestation being screened for ABO incompatibility learns that her blood contains anti-A antibodies. What should the nurse explain about this finding? a. "You may have contracted anti-A antibodies as a result of a viral infection." b. "It's most likely that you contracted anti-A antibodies through sexual activity." c. "Anti-A antibodies are inherited; usually, they are genetically passed down from father to daughter." d. "Anti-A antibodies occur naturally, as a result of exposure to foods and different infections."

d (Women develop anti-A and anti-B antibodies as a result of exposure to the A and B antigens through infection by gram-negative bacteria and not viruses. Anti-A and anti-B antibodies are naturally occurring; that is, women are naturally exposed to the A and B antigens through the foods they eat and through exposure to infection by gram-negative bacteria. These antibodies are not contracted through sexual activity. Women develop anti-A and anti-B antibodies naturally as a result of exposure to the A and B antigens through the foods they eat and through exposure to infection by gram-negative bacteria. These antibodies are not inherited. Anti-A and anti-B antibodies are naturally occurring; that is, women are naturally exposed to the A and B antigens through the foods they eat and through exposure to infection by gram-negative bacteria.)

It has been identified that a pregnant client's diet is low in zinc. Which food should the nurse suggest to increase intake of this mineral? a. Yogurt b. Bananas c. Cabbage d. Shellfish

d (Yogurt is high in other nutrients but does not have significant levels of zinc. Bananas are high in other nutrients but do not have significant levels of zinc. Cabbage is high in other nutrients but does not have significant levels of zinc. Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also tend to be high in zinc.)