GNP3 Maternity Rotation Chapter 15: Pregnancy
A nurse is discussing sexual intercourse during pregnancy with a client. Which statement by the client would indicate that learning has occurred?
"As long as the baby and I both continue to do well, I can have intercourse." Explanation: Barring complications, couples can continue to engage in sexual intercourse to the extent it is comfortable and desired. Oxytocin released during orgasm is not enough to induce preterm labor. The nurse should educate the client about other positions that might be more comfortable to use for intercourse during pregnancy, including the male and pregnant female anatomy during intercourse so the client can understand the lack of risk for injury.
A client who is 4 months' pregnant tells that nurse about providing foster care for stray cats from the nearby animal shelter until they are adopted. What information would be important for the nurse to stress to the client?
"Have your partner or friend change the cats' litter." Explanation: Toxoplasmosis, a protozoan infection, may be contracted through handling cat stool in soil or cat litter. Removing a cat from the home during pregnancy as a means of prevention is not necessary as long as the cat is healthy. However, taking in a new cat, which could be infected, is unwise. The pregnant client should be instructed not to change a cat litter box or garden in the soil in an area where cats may defecate to avoid exposure to the disease. Cleaning the cat's dish is acceptable. Scratches do not cause the disease.
After teaching a group of expectant mothers about how to best protect the fetus while in utero, which statement by a mother would best validate understanding of the teaching session?
"I will not take any medicines that the doctor has not prescribed without checking first." Explanation: Expectant mothers must understand that they are not to take any medication, even over-the-counter ones, unless the doctor has approved them. Immunizations may also cross the placenta and adversely affect the fetus. Rubella is one that will devastate a fetus if it crosses the placenta, which will occur with immunization of the mother. Herbal products are also included in this warning.
A pregnant client is scheduled to undergo chorionic villus sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?
10 to 12 weeks' gestation Explanation: Chorionic villus sampling (CVS) is typically performed between 10 to 12 weeks' gestation. Sometimes it may be offered up to 14 weeks. The test is not conducted before 10 weeks' gestation.
A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client?
16 weeks Explanation: The nurse should tell the client that an amniocentesis is typically scheduled between 15 and 18 weeks' gestation.
The nurse is caring for four pregnant clients. Which client will the nurse highlight for the health care provider as being at highest risk for carrying a child with a genetic abnormality?
36-year-old client with thalassemia whose partner is 55 years of age and who have a son with Duchenne muscular dystrophy Explanation: The nurse knows the 36-year-old client with thalassemia whose partner is 55 years of age and have a son with Duchenne muscular dystrophy is at highest risk with 3 risk factors. Maternal age of 35 or older, paternal age 50 or older, having a genetic disorder (such as thalassemia or hemophilia) already having a child with a genetic disorder (such as Duchenne muscular dystrophy), family history of genetic disorders, and exposure to a known risk factor (such as certain drugs or infections) are all known risk factors. Nongenetic disorders which are not risk factors include type 2 diabetes, hypoplastic left heart syndrome, hypertension, and schizophrenia.
A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:
4 weeks. Explanation: The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.
A client who has one child with a genetic disorder tells the nurse, "I told my husband I was ready to have another baby and now he does not want to be intimate with me." What is the most appropriate nursing diagnosis for this client's husband?
Altered sexuality pattern related to fear Explanation: The client's husband may be not engaging in intercourse because he is afraid of conceiving a second child with a genetic disorder. The nurse should identify resources for the client that allow for increased communication and education for the couple.
The nurse is preparing to assess the nutritional status of a client who is 8 weeks pregnant. What is the most effective way for the nurse to assess the client's food intake thus far in the pregnancy?
Ask the client to describe intake for the last 24 hours. Explanation: The best method for assessing a woman's nutritional intake during pregnancy is to ask the client to list all the food eaten within the past 24 hours, starting with waking up until going to sleep. This method of history-taking yields much more accurate information than asking a client how often a specific food is eaten. Assessing skin status may provide more information about hydration than nutritional status. Assessing a total intake for a week would be too extreme for the client to recall. Assessing the client from a list of foods does not identify what the client has most recently eaten.
A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found?
Halfway between the symphysis pubis and the umbilicus Explanation: As the pregnancy progresses, the uterus enlarges and enters the abdominal cavity. At 16 weeks, the nurse should be able to palpate the uterus halfway between the symphysis pubis and the umbilicus.
What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?
Ask her to describe her intake for the last 24 hours. Explanation: A 24-hour food intake history is the best method to assess food intake in all individuals.
A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy?
Client does not have cervical insufficiency. Explanation: The nurse should inform the client that sexual activity is permissible during pregnancy unless there is a history of cervical insufficiency, vaginal bleeding, placenta previa, risk of preterm labor, multiple gestation, premature rupture of membranes, or presence of any infection. Anemia and facial and hand edema would be contraindications to exercising but not intercourse. Freedom from anxieties and worries contributes to adequate sleep promotion.
The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate?
Do you have a cat in the house?" Explanation: Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.
A client is 6 weeks' pregnant. The client reports being nauseated every morning. Which measure will the nurse suggest the client use to help relieve nausea?
Eat several dry crackers before getting out of bed. Explanation: The traditional solution for preventing nausea is for the pregnant client to keep dry crackers, such as saltines, by the bedside and eat a few before rising because increasing carbohydrate intake seems to relieve nausea better than any other nutrition remedy. The client can then eat a light breakfast or delay breakfast until 10 or 11 AM, which is past the time nausea seems to persist. Aspirin is irritating to the stomach and should not be taken. Delaying toothbrushing does not affect nausea. A teaspoon of baking soda should not be suggested, because this could adversely affect the client's electrolyte status.
A postpartum woman who has experienced diastasis recti asks the nurse about what to expect related to this condition. Which response by the nurse would be most appropriate?
Exercise will help to improve the muscles." Explanation: Separation of the rectus abdominis muscles, called diastasis recti, is more common in women who have poor abdominal muscle tone before pregnancy. After birth, muscle tone is diminished and the abdominal muscles are soft and flabby. Specific exercises are necessary to help the woman regain muscle tone. Fortunately, diastasis responds well to exercise, and abdominal muscle tone can be improved. Stretch marks (striae gravidarum) fade to silvery lines. The darkened pigmentation of the abdomen (linea nigra), face (melasma/chloasma), and nipples gradually fades. Parous women will note a permanent increase in shoe size.
A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage?
From fertilization to the end of the second week after fertilization Explanation: The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.
A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage?
From fertilization to the end of the second week after fertilization Explanation: The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.
A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?
Fundal height has dropped since the last recording. Explanation: Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).
The nurse is assessing the pregnant client and notices that the client appears to have nasal congestion. When asking about this condition, which statement requires further instruction?
I find it most helpful to use a medicated nasal spray at night." Explanation: The nurse will educate the client if the client states they are using a medicated nasal spray. Medicated nasal sprays may lead to or cause exacerbation of hypertension. For this reason, the nurse would clarify that this action is to be avoided. The client correctly identifies that nasal congestion is a discomfort of pregnancy. The nasal mucosa swells in relation to venous congestion and causes stuffiness. Both using additional pillows and a humidifier may be helpful.
A nurse is teaching a pregnant client about alcohol and its effects during pregnant. The nurse determines that the teaching was successful based on which client statement?
I need to avoid any type of alcohol while I am pregnant." Explanation: There is evidence to confirm that people who consume large quantities of alcohol during pregnancy can have children with congenital craniofacial deformities. It is impossible for the nurse to define a safe level of alcohol consumption. The nurse should screen pregnant clients alcohol use at a first prenatal visit and advised to abstain from alcohol completely for the remainder of the pregnancy. The nurse should refer pregnant clients with alcohol use disorder to an alcohol treatment program as early in pregnancy as possible to help them reduce their alcohol intake.
A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next?
Inform the client this is a normal response to pregnancy that many women experience. Explanation: The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.
A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply.
Limit consumption of food before bedtime. Sleep in a semi-Fowler position. Avoid overeating. Explanation: When caring for a pregnant client with heartburn, the nurse should instruct the client to limit consuming foods before bedtime. The nurse should also instruct the client to sleep in a semi-Fowler position and to avoid overeating. The nurse need not instruct the client to avoid the use of antacids. On the contrary, antacids are known to be useful for heartburn even during pregnancy. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?
Maintain tolerable intensity of exercise. Explanation: Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.
A client makes an appointment with an obstetrician and assessment reveals positive Hegar and Chadwick signs. What should the nurse teach the client about these results?
She is probably pregnant, but this must be confirmed by other means Explanation: These are probable signs of pregnancy that can be detected by a trained examiner. However, positive signs must confirm this.
The nurse is praising an adolescent for seeking health care as soon as the adolescent found out about being pregnant. Which nursing intervention is the priority for this client in the first trimester of pregnancy?
Make sure the client receives nutritional counseling and reinforce the teaching. Explanation: There are many important nursing interventions for an adolescent who is pregnant. Nutritional counseling must be emphasized as part of prenatal care for adolescent clients because adolescents already have higher nutritional demands due to their growth status. Nutrition is also a priority due to the fetus' development. Adolescents are not at increased risk for developing gestational diabetes, so the client does not need a glucose tolerance test at this time. Adolescents do need 8 to 10 hours of sleep per night, but this is not the priority education over nutrition education. Instruction on fetal development at the first visit may be overwhelming and is not the priority at this time.
A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual?
Some women experience orgasm intensely during pregnancy. Explanation: Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.
A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate?
Prepare the client for an induction of labor. Explanation: Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone.
A primigravid client states that she has heard that her nipples will leak milk during the pregnancy and is concerned of embarrassment if this should happen while she is at work. Which nursing suggestion is best?
Purchase a padded supportive bra to wear under your clothing. Explanation: The breasts prepare for breastfeeding even before birth of the infant. At about the 16th week of pregnancy, colostrum secretion begins in the breasts. The best suggestion is to wear a padded, supportive bra that can absorb the leakage without it coming through the clothing. Having a change of clothes does not prevent the problem, and it may be noticeable that clothing has been changed. Limiting fluid intake is not suggested. The pregnant woman needs to remain hydrated. Placing tape on the nipples may harm the nipples and, although accepted in a few cultures, is discouraged.
A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action?
Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. Explanation: The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her?
Rest on the left side for at least 1 hour in the morning and afternoon. Explanation: During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.
A pregnant client at 32 weeks' gestation remarks during a routine prenatal visit, "Sex is becoming difficult for us." Which would be the best response by the nurse?
Sex during pregnancy is a common concern. What do you mean by difficult?" Explanation: Frank discussion about how sexual feelings and behaviors may change during pregnancy can help prevent and alleviate problems. The nurse should seek more information from the pregnant client regarding the difficulties that are encountered. Decreasing the frequency of sex or telling the client to abstain until after the birth does not address the cause of the difficulty. Discomfort should not be an issue, and if present should be investigated.
A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response?
The enlarging uterus pushes against your diaphragm and this makes breathing shallow." Explanation: Increasing levels of progesterone cause relaxation of ligaments and joints. This allows the rib cage to flare to accommodate the enlarging uterus. As the uterus enlarges, it pushes up against the diaphragm. This changes respirations from abdominal to costal, and the woman feels short of breath. The nurse should never demean a client's symptoms. Oxygen requirements do increase during pregnancy, but this not the reason for the woman's shortness of breath.
A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?
Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. Explanation: Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.
During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?
Turn the client on her left side. Explanation: As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.
Which pregnant woman should consult with her obstetric provider before continuing an exercise program?
a 33-year-old G5P1 with a history of cervical insufficiency Explanation: Women who know they have cervical insufficiency or have had cerclage to correct this should consult with their obstetric provider before beginning or continuing an exercise program. The other pregnant females can continue their exercise programs with the routine precautions outlined.
The nurse is planning a seminar that focuses on the 2030 National Health Goals during pregnancy for clients who are in the first trimester of pregnancy. Which information should the nurse include in this seminar? Select all that apply.
abstaining from drugs and substances maintaining health appointments refusing alcohol importance to stop smoking Explanation: The 2030 National Health Goals for pregnancy include objectives to abstain from social and binge alcohol intake, avoid smoking, receive prenatal care, and abstain from illicit drugs. Seeking alternative care approaches is not a 2020 National Health Goal for pregnancy.
A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain?
acetaminophen Explanation: Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.
A woman needing home care will be discharged from an antepartum unit in 3 hours. The woman will be monitored for BP and blood glucose, and instruction will be given regarding her self-administration of subcutaneous heparin. The agency is contacted and arrangements are made for which person to make the initial visit?
an RN Explanation: Home care is always based on an assessment by an RN. The RN makes the determination of which health care personnel has the level of education best suited to provide care to this woman.
A woman in early pregnancy asks the nurse why she has palmar erythema. The nurse's reply would be based on the principle that palmar erythema is most likely caused by which of the following?
an increased estrogen level Explanation: The cause of palmar erythema during early pregnancy is unknown but is attributed to the increasing estrogen level.
The nurse is caring for a client who has a retroverted uterus. The nurse would explain that this means her:
entire uterus is tipped backward. Explanation: Retroverted means to tip backward; retroversion means to bend backward.
A nurse is providing prenatal care to a pregnant woman. Understanding a major component of this care, the nurse would conduct a risk assessment for:
genetic conditions and disorders. Explanation: Nurses at all levels should be participating in risk assessment for genetic conditions and disorders, explaining genetic risk and genetic testing, and supporting informed health decisions and opportunities for early intervention.
The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize?
gestational age, length, weight, and systems developed Explanation: Client education is a major component of maternal-child nursing. During pregnancy, nurses provide anticipatory guidance to prepare the woman and her significant other for the changes each month brings. Clients most often want to know gestational age in weeks, length, weight, and systems developed; the client is then able to visualize what the fetus looks like.
A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, what would the nurse expect to find? Select all that apply.
hyperemic gums reports of bloating heartburn nausea Explanation: Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid indigestion and heartburn; bloating and nausea and vomiting.
A 33-year-old G1 P0000 patient is on home care for preterm contractions. The client tells her home care nurse that she is afraid to have a bowel movement and has stopped taking her iron supplement. The nurse teaches the client the importance of iron and also suggests:
increasing her intake of oatmeal with milk. Explanation: Increasing intake of fiber and fluids will help prevent constipation. The client should not limit a nutritional source of iron such as green leafy vegetables, or sources of fiber such as vegetables and protein. Fried corn chips are not a nutritious source of fiber.
A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?
iron-deficiency anemia Explanation: Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?
severe dehydration resulting in hypoperfusion of the placenta Explanation: With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketonuria impacts the fetus' neurologic development but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.
A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone?
maintains the endometrial lining of the uterus during pregnancy Explanation: Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.
The nurse is emphasizing the importance of adequate rest and sleep with a pregnant client. Which position should the nurse suggest the client use?
on the side with the weight of the uterus on the bed Explanation: A good resting or sleeping position for a pregnant client is a left-sided Sims position, with the top leg forward. This position puts the weight of the fetus on the bed, not on the woman, and allows good circulation in lower extremities. Lying on the back could cause the weight of the uterus to occlude the inferior vena cava, impeding blood flow to the client and fetus. Stomach lying is not a reasonable option with the size of the uterus.
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care?
once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Explanation: The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.
A nurse is assessing a pregnant women in her second trimester and obtains a urine sample for analysis. When reviewing the results, which finding would cause the nurse to be concerned?
serum creatinine: 1.2 mg/100 ml (106 µmol/L) Explanation: During pregnancy, the urinary system undergoes many physiologic changes, including alterations in fluid retention and renal, ureter, and bladder function. Glomerular filtration rate increases by 50%, BUN decreases by 25%, and creatinine decreases. A serum creatinine greater than 1 mg/100 ml (88.40 µmol/L) is abnormal and would be a cause for concern. A BUN of 15 mg/100 ml (5.35 mmol/L) or higher is abnormal. A creatinine clearance should be 90 to 180 ml/min (1.50 to 3.01 mL/s/m2) in a 24-hour urine sample.
During the initial prenatal visit, a client indicates that she frequently experiences stress incontinence. Which of the following should the nurse recommend to the client to help relieve this condition?
perform Kegel exercises Explanation: As part of any woman's gynecologic history, assess for the possibility of stress incontinence (incontinence of urine on laughing, coughing, deep inspiration, jogging, or running). Women can relieve stress incontinence to some degree by strengthening perineal muscles with the use of Kegel exercises. Perineal self-examination is inspecting the external genitalia monthly for signs of infection or lesions. Reduction of fluid intake should not be encouraged, as this could lead to dehydration. Increasing intake of water would not relieve stress incontinence, but rather would more likely make it worse, due to the bladder being even more distended with the increased volume of fluid.
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?
potential for greater than usual back pain Explanation: Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.
A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following?
relaxin Explanation: Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.
A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone?
relaxin Explanation: Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilation (dilatation) at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective and thereby allowing more glucose to become available for fetal growth.
The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting?
separation of the muscles of the abdominal wall Explanation: By 20 weeks' gestation, muscles of the abdominal wall may begin to separate (diastasis recti) and not return to normal approximation until several weeks after childbirth. The term diastasis recti does not refer to the raising of the uterus into the abdomen, relaxation of the kidneys, or movement of the bladder.
A number of inherited diseases can be detected in utero by amniocentesis. Which disease can be detected by this method?
trisomy 21 (Down syndrome) Explanation: Karyotyping for chromosomal defects can be carried out using amniocentesis.
The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time?
urinary frequency Explanation: Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.
A nurse is teaching a pregnant client in her first trimester about discomforts that she may experience. The nurse determines that the teaching was successful when the woman identifies which discomforts as common during the first trimester? Select all that apply.
urinary frequency breast tenderness cravings Explanation: Discomforts common in the first trimester include urinary frequency, breast tenderness, and cravings. Backache and leg cramps are common during the second trimester. Legs cramps are also common during the third trimester.
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?
vaginal bleeding Explanation: In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.
A nurse is assessing a pregnant client. Which of the following would the nurse document as an abnormal finding in a pregnancy?
visual changes Explanation: Visual changes are not seen in a normal pregnancy. They are only seen in the case of pregnancy-induced hypertension. Lordosis, pedal edema, and linea nigra are changes seen in a normal pregnancy.
