NUR 497 Maternity

A 25-year-old woman arrives on the maternity unit on February 2. She states that her estimated date of delivery (EDD) is March 22. She is verbalizing complaints of dull lower back pain, pelvic heaviness, and diarrhea for the past few days. On admission for observation, the client's blood pressure is 128/80 mm Hg, pulse is 100 beats/minute, respirations are 16 breaths/minute, and temperature is 37.2º C (99º F). The nurse plans care based on which interpretation? 1.The woman requires further evaluation for preterm labor. 2.The woman is suffering from an intestinal bacterial infection. 3.The woman is exhibiting signs and symptoms of gestational hypertension. 4.The woman needs instruction on pelvic tilts to decrease her lower back pain.

1

A nulliparous woman asks the nurse when she will begin to feel fetal movements. The nurse responds by telling the woman that the first recognition of fetal movement will occur at approximately how many weeks of gestation? 1.5 weeks 2.9 weeks 3.13 weeks 4.18 weeks

4

During a woman's 38-week prenatal visit, the nurse assesses the fetal heart rate to be 180 beats/minute. What might the nurse suspect as the most likely cause of this tachycardia? 1.Maternal infection 2.Gestational hypertension 3.Gestational diabetes mellitus 4.Consumption of recent high-sugar snack

1

In the prenatal clinic, the nurse is interviewing a new client and obtaining health history information. Which action should the nurse plan to elicit the most accurate responses to the questions that refer to sexually transmitted infections? 1.Establish a therapeutic relationship. 2.Use specific closed-ended questions. 3.Omit these types of questions because they are highly personal. 4.Apologize for the embarrassment that these questions will cause the client.

1

The clinic nurse is discussing nutrition with a pregnant client who has lactose intolerance. Which food should the nurse instruct the client to eat to supplement the dietary source of calcium? 1.Broccoli 2.Creamed spinach 3.Pasta with parmesan cheese 4.Freshly squeezed orange juice

1

The nurse is assisting in conducting a prenatal session with a group of expectant parents. One of the expectant parents asks, "How does the milk get secreted from the breast?" What should be the nurse's response? 1."Prolactin stimulates the secretion of milk, which is called lactogenesis." 2."Oxytocin stimulates the secretion of milk, which is called lactogenesis." 3."Progesterone stimulates the secretion of milk, which is called lactogenesis." 4."Testosterone stimulates the secretion of milk, which is called lactogenesis."

1

The nurse is assisting the primary health care provider to perform Leopold's maneuvers on a pregnant client. Which action should the nurse perform before the procedure? 1.Ask the client to urinate. 2.Ask the client to drink 8 oz of water. 3.Locate the fetal heart tones with a fetoscope. 4.Warm the sonogram gel before placing it on the client's abdomen.

1

The nurse is performing a physical assessment on a client during her first prenatal visit to the clinic. The nurse takes the client's temperature and notes that it is 37.3º C (99.2º F). Based on this finding, which nursing action is most appropriate? 1.Document the temperature. 2.Notify the primary health care provider. 3.Retake the temperature by the rectal route. 4.Inform the client that the temperature is elevated and antibiotics may be required.

1 (normal temperature during pregnancy is 36.2°C-37.6°C / 98°F-99.6°F)

The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply. 1.Allows for fetal movement 2.Surrounds, cushions, and protects the fetus 3.Maintains the body temperature of the fetus 4.Can be used to measure fetal kidney function 5.Prevents large particles such as bacteria from passing to the fetus 6.Provides an exchange of nutrients and waste products between the mother and the fetus

1,2,3,4

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. 1.Proteinuria 2.Hypertension 3.Low-grade fever 4.Generalized edema 5.Increased pulse rate 6.Increased respiratory rate

1,2,4 The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. A low-grade fever, increased pulse rate, or increased respiratory rate is not associated with preeclampsia.

The nurse in the gynecology clinic is reviewing the record of a pregnant client after the first prenatal visit. The nurse notes that the health care provider has documented that the woman has a platypelloid pelvis. On the basis of this documentation, the nurse anticipates which possible outcomes? Select all that apply. 1.Places the client at risk for dystocia 2.Has an increased probability of cesarean section 3.Is roomy and most conducive to a vaginal birth 4.Places the client at high risk for precipitous labor 5.Has a flat shape that may impede fetal descent 6.Has an oval shape that will require cesarean section

1,2,5

The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The primary health care provider has documented the presence of first trimester pregnancy signs. Which signs should the nurse anticipate as being present during this time frame? Select all that apply. 1.Hegar's sign 2.Babinski's sign 3.Ortolani's sign 4.Goodell's sign 5.Chadwick's sign

1,4,5

The nursing instructor asks the nursing student about the physiology related to the cessation of ovulation that occurs during pregnancy. Which response, if made by the student, indicates an understanding of this physiological process? Select all that apply. 1."Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high." 2."Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are low." 3."The low levels of estrogen and progesterone increase the release of the follicle-stimulating hormone and luteinizing hormone." 4."The high levels of estrogen and progesterone promote the release of the follicle-stimulating hormone and luteinizing hormone." 5."The release of the follicle-stimulating hormone and luteinizing hormone is inhibited by adaptations related to pregnancy."

1,5

A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. Her blood pressure during the past 3 weeks has been averaging 130/90 mm Hg. She has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the woman should alert the nurse to the worsening of gestational hypertension? 1."My vision for the past 2 days has been really fuzzy." 2."The swelling in my hands and ankles has gone down." 3."I had heartburn yesterday after I ate some spicy foods." 4."I had a headache yesterday, but I took some acetaminophen and it went away."

1. "My vision the past 2 days has been really fuzzy."Visual disturbances such as blurred vision, double vision, or spots before the eyes indicate arterial spasms and edema in the retina and may be a warning sign of worsening gestational hypertension. Resolution of swelling is not an indicator of preeclampsia. Heartburn is a common discomfort of pregnancy, especially with intake of spicy foods. A continuous headache indicates poor cerebral perfusion; having just one headache that is relieved with medication is not an indicator of preeclampsia.

A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last normal menstrual period was October 19, 2020. Using Näegele's rule, which expected date of delivery should the nurse document in the client's chart? 1.July 12, 2021 2.July 26, 2021 3.August 12, 2021 4.August 26, 2021

2

A client in her second trimester of pregnancy is seen at the health care clinic. The nurse collects data from the client and notes that the fetal heart rate is 90 beats/minute. Which nursing action is appropriate? 1.Document the findings. 2.Notify the primary health care provider (PHCP). 3.Inform the client that everything is normal and fine. 4.Instruct the client to return to the clinic in 1 week for reevaluation of the fetal heart rate.

2

The nurse should make which statement to a pregnant client found to have a gynecoid pelvis? 1."Your type of pelvis has a narrow pubic arch." 2."Your type of pelvis is the most favorable for labor and birth." 3."Your type of pelvis is a wide pelvis, but it has a short diameter." 4."You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery."

2

The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart? 1. G = 3, T = 2, P = 0, A = 0, L = 1 2. G = 2, T = 1, P = 0, A = 0, L = 1 3. G = 1, T = 1, P = 1, A = 0, L = 1 4. G = 2, T = 0, P = 0, A = 0, L = 1

2 Rationale:Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term (longer than 37 weeks); P is preterm births, the number born before 37 weeks of gestation; A is abortions or miscarriages, the number of abortions or miscarriages (included in gravida if before 20 weeks of gestation; included in parity if past 20 weeks of gestation); and L is the number of current living children. A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. The number of abortions is 0, and the number of living children is 1.

A nursing instructor asks a nursing student to describe the process of quickening. Which statements by the student indicate an understanding of this term? Select all that apply. 1. "It is the thinning of the lower uterine segment." 2. "It is the fetal movement that is felt by the mother." 3. "It is irregular, painless contractions that occur throughout pregnancy." 4. "It is the soft blowing sound that can be heard when the uterus is auscultated." 5. "It is a process that occurs in the pregnant woman as early as 16 weeks but definitely by week 20."

2,5

A pregnant client who is at 30 weeks' gestation comes to the clinic for a routine visit, and the nurse performs an assessment on her. Which observations made by the nurse during the assessment indicate a need for further teaching? Select all that apply. 1.The client is wearing sneakers. 2.The client is wearing knee-high nylon stockings. 3.The client is wearing flat shoes with rubber soles. 4.The client is wearing pants with an elastic waistband. 5.The client is wearing sweatpants with snug elastic ankle bands.

2,5

A prenatal woman with a history of heart disease has been instructed on care at home. Which statement, if made by the woman, indicates that she understands her needs? 1."My weight gain is not important." 2."I should avoid stressful situations." 3."I should rest by lying on my back." 4."There is no restriction on people who visit me."

2. "I should avoid stressful situations."Stress causes increased heart workload, and the client should be instructed to avoid stress. Too much weight gain can place further demands on the heart. Resting should be on the left side to promote blood return. To avoid infections, individuals with active infections should not be allowed to visit the client. Otherwise restrictions are not required.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction? 1."I will watch for the evidence of the passage of tissue." 2."I will maintain strict bed rest throughout the remainder of the pregnancy." 3."I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4."I will avoid sexual intercourse until the bleeding has stopped and for 2 weeks following the last evidence of bleeding."

2. Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.

A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate? 1.Contact the primary health care provider. 2.Instruct the client to maintain bed rest for the remainder of the pregnancy. 3.Inform the client that these contractions are common and may occur throughout the pregnancy. 4.Call the maternity unit and inform them that the client will be admitted in a preterm labor condition.

3

The home care nurse is visiting a prenatal client who has a history of heart disease. The nurse provides instructions to the client regarding home care measures to promote a healthy pregnancy and includes which measure in that instruction? 1. Increase daily calories to ensure weight gain. 2. Maintain a supine position during rest periods. 3. Restrict visitors who may have an active infection. 4. Avoid becoming concerned about placing stress on the heart.

3

The nurse is collecting data from a client who is at 32 weeks' gestation. The nurse measures the fundal height in centimeters and expects the findings to be how many centimeters (cm)? 1.22 cm 2.28 cm 3.32 cm 4.40 cm

3

The nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to risk for abruptio placentae if which information is obtained on assessment? 1.The client is 28 years of age. 2.This is the second pregnancy. 3.The client has a history of hypertension. 4.The client performs moderate exercise on a regular daily schedule.

3

The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide? 1.Strict bed rest is required after the procedure. 2.Hospitalization is necessary for 24 hours after the procedure. 3.An informed consent needs to be signed before the procedure. 4.A fever is expected after the procedure because of the trauma to the abdomen.

3

The nurse is reviewing the record of a pregnant woman and notes that the primary health care provider has documented the presence of Chadwick's sign. Which assessment finding supports the presence of Chadwick's sign? 1.Darkening of the areola 2.Softening of the uterine isthmus 3.Bluish discoloration of cervix and vagina 4.Palpation of the uterus above the level of the symphysis pubis

3

The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus? 1."It connects the pulmonary artery to the aorta." 2."It is an opening between the right and left atria." 3."It connects the umbilical vein to the inferior vena cava." 4."It connects the umbilical artery to the inferior vena cava."

3

The result of a biophysical profile (BPP) of a 28-year-old client at 36 weeks' gestation after the ultrasound components is 8. Based on this result, the nurse should take which action? 1. Prepare the client for labor induction. 2. Notify the primary health care provider (PHCP). 3. Place the fetal heart monitor on the client in order to do a nonstress test (NST). 4. Provide the client with information regarding warning signs and symptoms of pregnancy and discharge her to home.

3

The nurse provides instructions to a malnourished pregnant client regarding iron supplementation. Which client statement indicates an understanding of the instructions? 1."Iron supplements will give me diarrhea." 2."Meat does not provide iron and should be avoided." 3."The iron is best absorbed if taken on an empty stomach." 4."On the days that I eat green leafy vegetables or calf liver, I can omit taking the iron supplement."

3 "The iron is best absorbed if taken on an empty stomach."Iron is needed to allow for transfer of adequate iron to the fetus and to permit expansion of the maternal red blood cell mass. During pregnancy, the relative excess of plasma causes a decrease in the hemoglobin concentration and hematocrit, known as physiological anemia of pregnancy. This is a normal adaptation during pregnancy. Iron is best absorbed if taken on an empty stomach with water or a vitamin C containing juice. Iron supplements usually cause constipation. Meats are an excellent source of iron. The client needs to take the iron supplements regardless of food intake.

A contraction stress test is scheduled for a pregnant woman, and she asks the nurse to describe the test. What should the nurse include in the teaching? Select all that apply. 1. Uterine contractions are stimulated by Leopold's maneuvers. 2. An external fetal monitor is attached, and the woman ambulates on a treadmill until contractions begin. 3. An external monitor is attached in order to view fetal heart rate response to an established contraction pattern. 4. The uterus is stimulated to contract by the administration of small amounts of oxytocin or by nipple stimulation. 5. Small amounts of oxytocin are administered during internal fetal monitoring to stimulate uterine contractions.

3,4

A 39-week-gestation pregnant client calls the maternity unit, stating, "My baby has not moved very much in the past few days. Should I be concerned?" Which is the best response made by the nurse? 1."Six to eight fetal movements in a 24-hour period are adequate to determine that the fetus is healthy." 2."Fetal movement is a sign of fetal health. Even if the amount has decreased, the fetus is still healthy." 3."Continue to count fetal movements for the next 24 hours and call your primary health care provider if the number of movements continues to decrease." 4."Fetal movements do not decrease as a woman nears term; therefore, you should be seen by your primary health care provider for further evaluation."

4

A client who has just been told that she is pregnant wants to know when the baby's heart will be completely developed and beating. The nurse reads in the client's chart that the primary health care provider has determined the client to be at 6 weeks' gestation. What is the nurse's best response? 1."Your baby's heart right now consists of 2 parallel tubes, so we can't hear it today." 2."Your baby's heart right now is beginning to partition into 4 chambers and has begun to beat, so we should be able to hear it with a Doppler." 3."Your baby's heart right now is beginning to partition into 4 chambers and has begun to beat, so we should be able to hear it with a fetoscope." 4."Your baby's heart right now has double heart chambers and has begun to beat, so we should be able to see it beat using an ultrasound machine."

4

A pregnant woman in her second trimester calls the prenatal clinic nurse to report a recent exposure to a child with rubella. Which response by the nurse is most appropriate and supportive to the woman? 1."You should avoid all school-age children during pregnancy." 2."There is no need to be concerned if you don't have a fever or rash within the next 2 days." 3."Be sure to tell the primary health care provider on your next prenatal visit, but there is little risk in the second trimester." 4."You were wise to call. I will check your rubella titer screening results, and we can immediately identify whether future interventions are needed."

4

During a routine prenatal visit, a client complains of gums that bleed easily with brushing. The nurse performs an assessment and teaches the client about proper nutrition to minimize this problem. Which client statement indicates an understanding of the proper nutrition to minimize this problem? 1."I will drink 8 oz of water with each meal." 2."I will eat 3 servings of cracked wheat bread each day." 3."I will eat 2 saltine crackers before I get up each morning." 4."I will eat fresh fruits and vegetables for snacks and for dessert each day."

4

The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions? 1. "I should avoid between-meal snacks." 2. "I should lie down for an hour after eating." 3. "I should use spices for cooking rather than using salt." 4. "I should avoid eating foods that produce gas and fatty foods."

4

The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)? 1.Urinary output has increased. 2.Dependent edema has resolved. 3.Blood pressure reading is at the prenatal baseline. 4.The client complains of a headache and blurred vision.

4

The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)? 1.Urinary output has increased. 2.Dependent edema has resolved. 3.Blood pressure reading is at the prenatal baseline. 4.The client complains of a headache and blurred vision.

4

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement by the client indicates an understanding of self-care for this diagnosis? 1."I need to eat fruits and vegetables only." 2."I will go to the laboratory daily for a glucose test." 3."I cannot exercise because of the negative effects on insulin production." 4."I will report signs of infection immediately to my primary health care provider."

4

The nurse is interviewing a 16-year-old client during her initial prenatal clinic visit. The client is beginning week 18 of her first pregnancy. Which statement, if made by the client, indicates an immediate need for further investigation? 1."I don't like my figure anymore. My clothes are all too tight." 2."I don't like my breasts anymore. These silver lines are ugly." 3."I don't like my stomach anymore. That brown line is disgusting." 4."I don't like my face anymore. I always look like I have been crying."

4

The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36 weeks of gestation. During the measurement, the client begins to feel lightheaded. On the basis of knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of the lightheadedness? 1. A full bladder 2. Emotional instability 3. Insufficient iron intake 4. Compression of the vena cava

4

The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse? 1."I should increase my sodium intake during pregnancy." 2."I should lower my blood volume by limiting my fluids." 3."I should maintain a low-calorie diet to prevent any weight gain." 4."I should drink adequate fluids and increase my intake of high-fiber foods."

4

The nurse is taking a nutritional history from a 16-year-old pregnant adolescent. Which statement, if made by the adolescent, should alert the nurse to a potential psychosocial problem? 1."I don't like dairy products." 2."I will continue drinking my afternoon milkshake." 3."I'm not used to eating so much food, but I will try." 4."I want to gain only 10 pounds because I want to have a small, petite baby."

4

The nurse is providing instructions to a pregnant client visiting the antenatal clinic about foods that are rich in folic acid. Which food should the nurse encourage the client to consume because it is highest in folic acid? 1.Rice 2.Cheese 3.Chicken 4.Dried beans

4 Of the choices available, green leafy vegetables are highest in folic acid. Other sources of folic acid include whole grains, fruits, liver, dried peas, and beans. Chicken, rice, and cheese are not high in folic acid. Cheese is high in calcium, and rice and chicken are good sources of iron.