OB CHAPTER 12 PREP U

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." Explanation: While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing RhoGAM and having social issues does not place the client at risk for sexually transmitted infections.

A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her?

24 weeks

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." Explanation: The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern. Reference:

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 Explanation: The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting?

Limiting intake of heavy, greasy foods Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.

A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client?

Rest when possible with feet elevated at or above the heart. Explanation: Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-Fowler is not enough to alleviate the edema. Reference:

A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?

Sleep on your side. Explanation: Supine hypotension is a symptom that occurs when a woman lies on her back and the uterus presses on the vena cava, impairing blood return to her heart. A woman experiences an irregular heart rate and a feeling of apprehension. To relieve the problem is simple: if a woman turns or is turned onto her side, pressure is removed from the vena cava, blood flow is restored, and the symptoms quickly fade. To prevent the syndrome, advise pregnant women to always rest or sleep on their side, not their back. Sleeping face down is not advised, and sleeping with the feet elevated would not prevent compression of the vena cava.

The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. Explanation: A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?

excessive vomiting Explanation: Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy. Reference:

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological challenges Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions. Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.

During the initial history and physical of a 30-year-old primipara client, the nurse has identified some teratogens the fetus is being exposed to at this phase of the pregnancy. Which lifestyle data could result in teratogenic exposure to the fetus? Select all that apply.

smoking 2 packs of cigarettes a day working as a receptionist in a busy office where she copies documents drinking alcoholic beverages 3 times a week snorting cocaine once or twice a month Often, helping a woman plan to avoid teratogens is challenging because a total change in lifestyle and environment —such as not smoking, not drinking alcohol, or avoiding the use of recreational drugs—may be difficult. Fortunately, most women are highly motivated to complete a pregnancy satisfactorily, so they are usually willing to make changes for the health of the unborn fetus. Working in an office as a receptionist does not expose this client to teratogens. Women are encouraged to continue with their hobbies as long as teratogens are not involved. Painting pictures should not pose a threat to the fetus.

A pregnant adolescent asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe?

swimming Explanation: Sports that require balance (bicycling, skiing) become difficult during pregnancy. A high-impact aerobics program is usually contraindicated because it can be strenuous on both pelvic and knee joints. Swimming would be a safe activity to partake in during pregnancy.