Maternal Child Nursing Care Chapter 8 Nursing Care of the Family During Pregnancy

2 Estrogen levels increase during pregnancy and result in hyperemia of mucous membranes, which is characterized by nasal stuffiness and nose bleeding. Anemia is caused by low iron levels. High progesterone levels slow gastrointestinal tract motility and digestion, which may cause constipation. Low serum calcium levels cause gastrocnemius spasm.

During the first trimester of pregnancy, a patient reports nasal stuffiness and nose bleeding. What does the nurse identify as the probable reason? 1 Low iron level 2 High estrogen level 3 High progesterone level 4 Low serum calcium level

4 A triple marker test determines the levels of MSAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects. Low levels of MSAFP are associated with Down syndrome. Sickle cell anemia is not detected by the MSAFP. Cardiac defects are not detected with the MSAFP.

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: 1 Down syndrome. 2 sickle cell anemia. 3 cardiac defects. 4 open neural tube defects such as spina bifida

08/02/2015 According to Nägele's rule, the estimated birth date is calculated by adding 7 days to LMP and counting forward 9 months. Hence, because the patient's LMP is November 25, 2014, the expected birth date would be 25 + 7 days = 32 days (December 2, 2014), plus 9 months, for an EDB of August 2, 2015.

A patient reveals the first day of the last menstrual period (LMP) as November 25, 2014. After an assessment, the nurse confirms that the patient is pregnant. What will be the estimated date of birth (EDB)? Record as 00/00/0000.

4 Trial of labor after cesarean is the method in which the patient who has had a cesarean delivery previously attempts to have a vaginal delivery in the present pregnancy. The patient who has preterm birth risk would generally undergo a cesarean. Women who get pregnant at an older age are at a high risk for having pregnancy complications. These women usually have cesarean delivery. The patient who has a multifetal pregnancy would generally undergo a cesarean.

A pregnant patient asks the nurse about a trial of labor after cesarean. What is the patient's reason for asking about this? The patient is: 1 Having a preterm delivery. 2 In her late 30s. 3 Having multiple fetuses. 4 Attempting a vaginal birth.

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A pregnant patient asks the nurse, "How can I prevent blockage of the nipples while breastfeeding when my baby is born?" What cleaning instructions should the nurse provide to the patient regarding nipple care? 1 "Use soap." 2 "Apply tincture." 3 "Use alcohol." 4 "Rinse with warm water."

3 Because of their reduced gastrointestinal tract motility and intestinal compression, constipation is a common complaint among pregnant women. Gastrointestinal motility is reduced by changes in progesterone levels, which increases reabsorption of water. This in turn leads to the drying of stools, or constipation. Therefore the nurse should instruct the patient to drink six to eight glasses of water every day. During pregnancy, the nurse should not instruct the patient to take mineral oil or stool softener because they may be harmful to the fetus; these are prescribed only by the primary health care provider. Constipation may result from oral iron supplementation, but the nurse should not instruct the patient to stop taking iron supplementation because iron supplements are essential to prevent anemia.

A pregnant patient complains of constipation. While checking the patient's history, the nurse learns that the patient is taking oral iron supplements. What instruction does the nurse give the patient to relieve constipation? 1 "Drink mineral oil before going to bed." 2 "Take a stool softener before going to bed." 3 "Drink six to eight glasses of water every day." 4 "Discontinue taking iron supplements."

4 Elevated serum phosphorus levels cause leg cramps in pregnant patients. During pregnancy, hormonal changes occur in the body. Elevated estrogen levels cause nasal stuffiness, epistaxis, angiomas, and gingivitis. Elevated progesterone levels cause constipation. Leg cramps (gastrocnemius spasm) are caused when serum calcium levels are low.

A pregnant patient reports severe leg cramps, especially in the reclining posture. The nurse assesses the patient's laboratory reports. Which factor is responsible for the leg cramps in the patient? 1 Elevated estrogen level 2 Elevated progesterone level 3 Elevated serum calcium level 4 Elevated serum phosphorus level

1, 2, 4 The nurse should instruct the patient to drink cranberry juice and acidophilus milk, because they have antibacterial properties and help prevent recurrence of urinary tract infections. The nurse should advise the patient to drink at least 2 liters of fluids per day to maintain adequate hydration. This also promotes optimal urination and prevents bacterial infection. The nurse should instruct the patient to avoid bubble baths because they can irritate the urethra. The nurse should instruct the patient to avoid using scented toilet paper because it may irritate the genitourinary tissues.

A pregnant patient with a urinary tract infection is being discharged from the hospital after recovery. What preventive measures does the nurse suggest to the patient? Select all that apply. 1 "Drink cranberry juice." 2 "Drink acidophilus milk." 3 "Regularly take bubble baths." 4 "Drink 2 liters of fluids daily." 5 "Use scented toilet paper.

2 The client works in a manufacturing unit and needs to stand for prolonged periods. During pregnancy, the patient should neither stand nor sit for prolonged periods because doing so may adversely affect fetal health. Therefore the nurse instructs the patient to not stand for a prolonged period so as to reduce the risk for preterm labor. Leg cramps result from reduced levels of diffusible serum calcium or an elevation in serum phosphorus levels. Thrombophlebitis can result from sitting with crossed legs for prolonged periods. Carpal tunnel syndrome results from compression of the median nerve that results from the changes in the surrounding tissues; it is not caused by prolonged standing or sitting.

A pregnant patient works as a supervisor in a manufacturing unit. The nurse advises the patient not to stand for prolonged periods, despite the demands of her occupation. Why should the pregnant patient not stand for prolonged periods? To lower the risk for: 1 Leg cramps 2 Preterm labor 3 Thrombophlebitis in the legs 4 Carpal tunnel syndrome

4 Sudden discharge of fluid from the vagina before 37 weeks indicates premature rupture of membranes. Severe backache or flank pain is sign of renal calculus (renal stone). Absence of fetal movements during the third trimester indicates intrauterine fetal death. A positive glucose tolerance test indicates gestational diabetes mellitus.

A pregnant woman reports a sudden discharge of fluid from the vagina before 37 weeks' gestation. What does the nurse infer from this observation? This is a sign of: 1 Renal calculus in the patient. 2 Intrauterine fetal death. 3 Gestational diabetes mellitus. 4 Premature rupture of membrane

2 An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: 1 constipation. 2 alteration in the pattern of fetal movement. 3 heart palpitations. 4 edema in the ankles and feet at the end of the day.

1, 2, 4 Carpal tunnel syndrome results from compression of the median nerve caused by changes in the surrounding tissues. Tingling, numbness, and dropping of objects are symptoms of carpal tunnel syndrome. It causes pain and loss of skilled movements. During pregnancy, the sweat glands are more active, and this results in increased sweating. Flatulence with bloating occurs during pregnancy because of reduced gastrointestinal motility caused by hormonal changes.

After assessing a pregnant patient, the nurse finds that the patient has carpal tunnel syndrome. Which symptoms helped the nurse to arrive at this conclusion? Select all that apply. 1 Tingling 2 Numbness 3 Increased sweating 4 Dropping of objects 5 Flatulence and bloating

4 Stable or decreasing fundal height indicates that fetal growth does not correspond to the mother's gestational age. This indicates intrauterine growth restriction of the fetus. Polyhydramnios is a condition in which the amniotic fluid volume is greater than normal. In this condition, fundal height is greater than normal. Multifetal gestation is the presence of more than one child. Maternal malnourishment may affect the growth of the fetus but is not directly associated with fundal height.

After reviewing the obstetric reports of a pregnant patient, the nurse finds that the patient's fundal height has not changed in the last 4 weeks. What condition does the nurse potentially interpret from this finding? 1 Polyhydramnios 2 Multifetal gestation 3 Maternal malnourishment 4 Intrauterine growth restriction (IUGR)

4 Uterine contractions that accompany orgasm can stimulate labor and can be problematic if the woman is at risk for or has a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: 1 intercourse should be avoided. 2 intercourse is safe until the third trimester. 3 safer-sex practices should be used once the membranes rupture. 4 intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

2 Placing a small towel under the patient's right hip decreases the direct pressure on the major vessels in the abdomen, which become compressed when the patient lies on her back. Infection control is not an issue at this time. Placing a pillow under her legs may make the patient more comfortable, but won't improve perfusion. Placing the patient on her right side does not allow for proper measurement while maximizing perfusion.

As the pregnancy progresses, the patient experiences shortness of breath when the fundal height is being assessed. What action should the nurse take to minimize the shortness of breath or dizziness as a result of the weight of the growing uterus? 1 Use a new paper tape measure for each visit to decrease infection. 2 Place a small towel under the patient's right hip. 3 Place a pillow under the patient's knees whenever she is on her back. 4 Place the patient on her right side while the measurement is done.

3 During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family is an appropriate topic for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester, a woman works on the task of, "I am going to have a baby." Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

During the first trimester, the pregnant woman is most motivated to learn about: 1 fetal development. 2 impact of a new baby on family members. 3 measures to reduce nausea and fatigue so she can feel better. 4 location of childbirth preparation and breastfeeding classes.

2 Persistent refusal to talk about the fetus may be a sign of a problem and should be assessed. Viewing the pregnancy with pride is normal. Expressing concern about fainting at the birth is normal. Experiencing pregnancy-like symptoms is called couvade syndrome.

If exhibited by an expectant father, what is a warning sign of ineffective adaptation to his partner's first pregnancy? 1 Views pregnancy with pride as a confirmation of his virility 2 Consistently changes the subject when the topic of the fetus/newborn is raised 3 Expresses concern that he might faint at the birth of his baby 4 Experiences nausea and fatigue, along with his partner, during the first trimester

4 From the assessment, the nurse concludes that development of the fetus is normal at 28 weeks' gestation. According to the standard measurement, fundal height (in centimeters) is approximately equal to the number of weeks of gestation. The patient's bladder should be empty while the nurse measures the fundal height. An excessive increase in fundal height indicates polyhydramnios or multifetal gestation. Vaginal bleeding and abdominal cramping during the first trimester of pregnancy indicate the possibility of an ectopic pregnancy.

On assessing a pregnant patient, the nurse finds that the patient's fundal height is 27 cm at 28 weeks' gestation. What does the nurse conclude from this finding? This measurement indicates: 1 Polyhydramnios. 2 Multifetal gestation. 3 Ectopic pregnancy. 4 Normal development.

3 Alcohol has teratogenic effects such as fetal alcohol syndrome. It causes devastating effects and impairs fetal development. Therefore, to prevent these teratogenic effects the nurse should advise the pregnant patient to avoid consuming alcohol. Angiomas (spider nevi) result from an increased concentration of estrogen in the pregnant women. They are not caused by alcohol consumption. Alcohol consumption has no effect on the urinary system. Gastrocnemius spasm results from low levels of diffusible serum calcium or elevation of serum phosphorus.

The nurse advises an alcoholic patient to stop consuming alcohol during pregnancy. What could be the reason for this? To prevent: 1 Angiomas in the fetus 2 Urinary infections in the patient 3 Teratogenic effect in the fetus 4 Gastrocnemius spasm in the patien

2 Varicose veins are observed in pregnant patients usually in the second or third trimesters. Prolonged sitting increases the blood pressure in the legs veins, causing varicose veins. Patients who spend more time sitting (e.g., at a desk job) have a high risk for developing varicose veins. Similarly, wearing tight-fitting pants can also affect the venous return and cause stasis of the blood in the veins. Constipation is another regularly observed complication during pregnancy. Increased intake of fiber and water is helpful to relieve constipation. Supine hypotension is caused when the abdominal contents compress the inferior vena cava in the supine position. This can be relieved by changing the positions when sleeping. Urinary tract infections can be prevented during pregnancy by increasing the intake of water and by emptying bladder regularly.

The nurse instructs a pregnant patient to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease? 1 Constipation 2 Varicose veins 3 Supine hypotension 4 Urinary tract infections

2 During an unplanned pregnancy, some partners find it difficult to accept the impending changes in life plans and lifestyles, but over time they adapt to the reality of pregnancy. Because the patient's partner is not mentally prepared for the baby, it is not advisable to ask the partner to play with children, develop a new hobby, or visit an orphanage.

The nurse is assessing a patient who has an unplanned pregnancy. The patient says to the nurse, "My partner is not happy that I'm pregnant." What should be a relevant response by the nurse? "Your partner should: 1 Be advised to play with children." 2 Be given adequate time to adapt to the idea of having a baby." 3 Be encouraged to develop a new hobby." 4 Visit an orphanage a for few days."

1 A pregnant patient usually has nausea and vomiting during the first trimester. The nurse should ensure proper nutrition by prescribing an appropriate diet plan. Ideally, the patient should gain 2 kg body weight by the end of the first trimester. Thus the patient should weigh 59 kg (57 + 2) by the end of her first trimester. Excess weight gain (62 kg) is not a good sign in pregnancy and could lead to complications such as gestational hypertension and gestational diabetes. Sleep disturbances and constipation are commonly observed in the second trimester of pregnancy. These problems are not associated with maternal weight gain or impaired nutrition.

The nurse is assessing a patient who weighs 57 kg in the first month of pregnancy. The nurse plans a diet regimen to provide adequate nutrition to the patient. Which assessment finding at the end of the third month would indicate that the diet prescribed was effective? The patient: 1 Weighs 59 kg. 2 Weighs 62 kg. 3 Has good-quality sleep. 4 Has regular bowel moments.

1, 4 Couvade syndrome is a condition in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. During this condition some emotional and physiologic changes are observed in the men. Couvade syndrome does not have any impact on the skin or throat. Therefore the patient will not have skin rashes, sore throat, or persistent cough.

The nurse is assessing a patient with couvade syndrome. What symptoms is the nurse likely to find? Select all that apply. 1 Nausea 2 Skin rashes 3 Sore throat 4 Weight gain 5 Persistent cough

2 If a pregnant patient has less than the recommended fluid intake, her urine could be of a dark color. Therefore the nurse should advise the patient to increase her fluid intake to help dilute her urine. Bubble baths are usually not recommended in pregnant women because they may irritate the urethra. The pregnant patient is advised to take dry carbohydrates to prevent vomiting during the first trimester of pregnancy, but a dry carbohydrate diet has no effect on the patient's urination patterns. Regular back rubs can ease back pain in the pregnant patient, but they have no effect in diluting the urine.

The nurse is assessing a pregnant patient who complains of painful urination. The patient says, "My urine is dark in color." What will the nurse tell the patient to do? 1 "Take bubble baths regularly." 2 "Increase your fluid intake." 3 "Include dry carbohydrates in your diet." 4 "Get regular back rubs."

2 Patients who have undergone bariatric surgery are at a high risk for impaired nutrition, so the nurse should regularly monitor the patient's nutritional status. The client's family history is considered to rule out the risk for congenital anomalies in the fetus, which is not necessary in this case. Blood glucose levels are monitored if the patient is at high risk for developing gestational diabetes during the first or last trimester. Blood pressure levels are usually monitored in the pregnant patient during regular visits to assess the risk for gestational hypertension.

The nurse is assessing a pregnant patient who has undergone bariatric surgery in the past. What will the nurse primarily check in the patient's health records? 1 Family history 2 Nutritional status 3 Blood glucose levels 4 Blood pressure

1 Transvaginal ultrasound is performed to determine the cervical length of a pregnant patient. When the cervical length is found to be short, the patient is at risk for preterm labor, and patients at risk for preterm labor are advised to avoid air travel. To prevent supine hypotension, the pregnant patient should be instructed on maintaining side-lying or semisitting postures. Avoiding air travel does not prevent supine hypotension. Peripartum hemorrhage occurs during delivery and cannot be prevented by avoiding air travel. Gestational hypertension is a pregnancy complication that is not affected by air travel.

The nurse is assessing the transvaginal ultrasound report of a pregnant patient. After assessment, the nurse instructs the patient to avoid air travel. What is the reason for giving this instruction? To prevent: 1 Preterm labor in the client 2 Supine hypotension 3 Peripartum hemorrhage 4 Gestational hypertension

4 Every pregnant patient should be taught about safety measures to prevent motor vehicle accidents. Automobile accidents may lead to placental separation, causing fetal death. This condition is called abruptio placentae. Preterm birth and ectopic pregnancy are not associated with automobile accidents. Thrombophlebitis is commonly observed in pregnant patients because the heavy abdominal contents compress the blood vessels. Pregnant patients are usually taught certain exercises to prevent thrombophlebitis.

The nurse is explaining to a pregnant patient about prevention of motor vehicle accidents. What risk is most associated with motor vehicle accidents in pregnant patients? 1 Preterm birth 2 Thrombophlebitis 3 Ectopic pregnancy 4 Abruptio placentae

1 An abdominal examination is part of a physical assessment. For abdominal examination, the patient lies on her back, and the weight of her abdominal contents compresses the vena cava and aorta, which results in supine hypotension. Therefore, during a physical assessment the nurse should place a small wedge under the patient's right hip to prevent supine hypotension. A back massage is helpful for promoting sleep, not for preventing supine hypotension. The nurse should instruct the patient to empty her bladder for fundal assessment, but emptying the bladder does not prevent supine hypotension. Intake of warm milk promotes sleep, but it does not prevent supine hypotension during a physical assessment.

The nurse is performing a physical assessment of a pregnant patient. What precaution will the nurse take to prevent supine hypotension in the patient? 1 Place a small wedge under the patient's right hip. 2 Give a back massage to the patient before assessment. 3 Instruct the patient to empty her bladder before assessment. 4 Instruct the patient to drink warm milk before assessment.

3 The pregnant patient has a family history of diabetes and may be at a high risk for developing gestational diabetes. Because the initial 1-hour glucose tolerance test results are normal, the patient should be advised to repeat the test again at 28 weeks of pregnancy. The patient has normal blood sugar levels and is therefore unlikely to have renal complications. The patient does not need to undergo a renal function test. The laboratory reports do not indicate that the patient has any nutritional deficiencies and does not indicate a need for the patient to increase her food intake. A 3-hour glucose test is conducted only for pregnant patients whose 1-hour glucose tolerance test is positive.

The nurse is reviewing the lab reports of a patient who is 10 weeks pregnant and has a family history of diabetes mellitus. The nurse finds that the patient's 1-hour glucose tolerance test is normal. What does the nurse advise the patient? 1 "Undergo a renal function test." 2 "Increase food intake." 3 "Repeat the test at 28 weeks." 4 "Undergo a 3-hour glucose test."

2 Intake of dry carbohydrate is recommended in pregnant patient's diet to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome.

The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret from this? The husband has: 1 Vena cava syndrome. 2 Couvade syndrome. 3 Carpal tunnel syndrome. 4 Brachial plexus traction syndrome.

2 The patient with a history of spinal surgery should not undergo epidural anesthesia. The patient with a history of appendectomy, uterine surgery, or pelvic floor problems can undergo epidural anesthesia.

The nurse works in a maternity unit. Which patient condition in her history would be a contraindication for epidural anesthesia during labor? 1 Appendectomy 2 Spinal surgery 3 Uterine surgery 4 Pelvic floor problems

1 A patient who is Rh negative or Rh unsensitized should receive 300 mcg immunoglobulin to prevent complications in the fetus related to Rh incompatibility. Elevated amniotic fluid volume (or polyhydramnios), streptococcal infection, and HIV infection cannot be treated with immunoglobulin. Severe polyhydramnios is treated by aspirating a small amount of amniotic fluid (amniocentesis). If a patient tests positive for group B streptococcal infection, antibiotic therapy is initiated. If the pregnant patient is HIV positive, antiretroviral drugs are administered to prevent transmission of infection from the mother to the child.

The primary health care provider has ordered 300 mcg of immunoglobulin to be delivered intramuscularly to a pregnant patient. What would be the reason for administering this to the patient? The patient: 1 Is Rh negative and unsensitized. 2 Has elevated amniotic fluid volume. 3 Has group B streptococcal infection. 4 Is human immunodeficiency virus (HIV) positive

1, 2, 4 Angiomas, gingivitis, and nose bleeding occur in the pregnant patient because of an increase in estrogen levels. Angiomas (spider nevi) appear on the neck, thorax, face, and arms during the second or third trimester of pregnancy. Estrogen increases vascularity and proliferation of the connective tissue. This results in gingivitis. Estrogen causes hyperemia of the mucous membranes. This results in nose bleeding. Constipation during pregnancy results from an increase in progesterone (not estrogen) levels. Gastrocnemius spasm during pregnancy is caused by a reduced level of diffusible serum calcium or an elevation of serum phosphorus.

Which signs and symptoms in a pregnant patient would the nurse attribute to elevated levels of estrogen? Select all that apply. 1 Angiomas 2 Gingivitis 3 Constipation 4 Nose bleeding 5 Gastrocnemius spasm

2 During pregnancy, gastrointestinal motility is reduced by changes in hormone levels. This increases bacterial action and results in gas production, which results in flatulence, bloating, and belching. Therefore, to improve digestion and prevent gas production, the nurse should advise the patient to chew foods slowly and thoroughly. Drinking acidophilus milk prevents urinary tract infection but does not help reduce flatulence. The patient should avoid consuming fatty food because it increases flatulence and belching. The patient should not increase fluid intake before bedtime because it may cause frequent urination.

While assessing a pregnant patient, the nurse finds that the patient has increased flatulence, bloating, and belching. Which intervention should the nurse suggest to reduce this discomfort? 1 "Drink acidophilus milk regularly." 2 "Chew foods slowly and thoroughly." 3 "Increase consumption of fatty food." 4 "Increase fluid intake before bedtime."

1 Prescription and OTC drugs can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: 1 prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. 2 the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. 3 killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. 4 no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

3 Emotional lability, rapid and unpredictable changes in mood, is related to hormone changes and anxiety during pregnancy. Stating that the woman's behavior is normal is correct but does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This statement is judgmental and not appropriate.

n expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: 1 "This is normal behavior and should begin to subside by the second trimester." 2 "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." 3 "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." 4 "You seem impatient with her. Perhaps this is precipitating her behavior."