Nursing Management During Pregnancy
A pregnant client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse?
"Acetaminophen is consider relatively safe to take for your headaches during your pregnancy."
The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age?
20 weeks
A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?
"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."
The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern?
"I am unsure who the father of the baby is. I will be raising it alone."
A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?
"I should substitute intercourse with nonsexual touch to avoid harming the fetus."
After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?
"I'll switch to chewing gum instead of using mints."
The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?
"The gloves they provide irritate my hands, so I don't use them."
When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?
"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."
The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?
24 cm
A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation?
24 weeks
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.
4, 1, 1, 1, 1
A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery?
April 27
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.
A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?
Avoid wearing high heels, especially during late pregnancy.
During the physical examination at the first prenatal visit a speculum examination is performed and a bluish-colored cervix is noted. How will the nurse interpret this finding?
Chadwick sign
A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?
Conduct an interview in a private room to obtain her health history.
The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:
December 30
A client at 27 weeks' gestation still walks daily but reports "terrible" heartburn at night. Which action should the nurse point out will best address this situation?
Elevate the head of the bed.
A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?
Further testing will be required to confirm any diagnosis.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:
G = 3, T = 1, P = 0, A = 1, L = 1
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1
A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?
Health-seeking behaviors related to ways to relieve discomforts of pregnancy
The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?
Helps the lungs remain expanded after the initiation of breathing
Why is a Papanicolaou test done at the first prenatal visit?
It identifies abnormal cervical cells.
A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?
July 16
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.
The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD?
September 8
The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?
Take antacid 1 hour after the multivitamin.
A client at 29 weeks' gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next?
Tell the client these are normal findings during pregnancy.
During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit?
The client reduces her smoking by 50 percent by the next clinic visit.
When describing the role of a doula to a group of pregnant women, the nurse would include which information?
The doula primarily focuses on providing continuous labor support.
The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?
Ultrasound equipment
The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client?
Walk for 30 minutes 5 days a week.
The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care?
Wash the nipples with clean water only.
A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?
Wear support hose.
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
A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information?
biophysical profile
What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)?
breasts
The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid?
citrus juice
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?
clean-catch urine
During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur?
fetal tachycardia
Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply.
measles mumps rubella
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
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
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy?
prepregnancy BMI
A client in her third trimester of pregnancy visits the health care center and asks why she is constipated. The nurse would include which most likely cause when responding to the client?
pressure on intestine by the growing fetus
The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?
rubella
The nurse educates the vegetarian client about which nutritional need during pregnancy?
taking a B12 supplement
The nurse is reviewing the charts of a group of clients. Which client's weight gain should the nurse be concerned about?
the client who gained 8 lb (4 kg) in the first 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
A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy?
"Babies of women who smoke tend to weigh significantly less than other infants."
Which finding is most worrisome in a client in her 26th week of pregnancy?
facial edema
The nurse has just received the results of a pregnant client's MSAFP screening and notes the levels are elevated. The nurse should prioritize which discussion with the client?
further testing is required
The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?
"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."
A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate?
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus."
At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?
Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.
The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility?
Hemolytic anemia
A pregnant client tells the nurse that she has a 2-year-old child at home who was born at 38 weeks; she had a miscarriage at 9 weeks; and she gave birth to a set of twins at 34 weeks. Which documentation would be appropriate for the nurse?
gravida 4, para 2