PrepU: Chapter 12: Nursing Management During Pregnancy
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
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.
Which question should the nurse include when conducting a review of systems with a patient during the first prenatal visit?
"Have you had any urinary tract infections?"
Which statement by the pregnant woman shows an understanding that she should avoid teratogens in the first trimester?
"I have to call my doctor to switch me from lithium to another drug for my bipolar disorder."
A nurse is teaching a client who is 30 weeks pregnant about ways to deal with heartburn. The nurse determines a need for additional teaching based on which client statement?
"I should lie down for 1/2 hour after eating."
After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client makes which statement?
"I'll sit comfortably in a recliner or lie on my side when I do the counts."
The nurse manager of a prenatal clinic has implemented interventions to individualize the prenatal care experience. Which patient statement indicates that the nurse's efforts have been successful?
"It was so nice to not have to wait long in the waiting room."
The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed?
"Pain with urination is expected during pregnancy."
During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." How should the nurse reply?
"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam."
The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?
20 cm
The nurse discovers a new prescription for RhoGAM for a client who is about to undergo a diagnostic procedure. The nurse will administer the RhoGAM after which procedure?
Amniocentesis
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
The blood tests for a primigravida client indicate that the client is Rh-negative and her partner is Rh-positive. What is an appropriate nursing intervention for this client?
Arrange for Rho immune globulin at 28 weeks' gestation
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.
What advice should the nurse provide to a patient who is 4 months pregnant and owns a cat?
Ask someone else to change the cat litter.
During pregnancy the cardinal rule regarding on taking medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?
Asthma
At the first prenatal visit, the client reports her LMP was November 16, 2017. The nurse determines the estimated due date to be:
August 23, 2018.
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?
Avoid medications
Why is the first prenatal visit usually the longest prenatal visit?
Baseline data is collected.
The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize?
Be certain she is aware of potential complications.
What anatomic area should be examined when assessing Montgomery tubercles?
Breasts
A pregnant patient tells the nurse that saturated fats are avoided by using vegetable oil. What additional information about vegetable oil can the nurse use to reinforce this patient's decision?
Contains linoleic acid
The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client?
Continue this as long as she enjoys it.
A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor?
Contractions beginning in the back and sweeping forward across the abdomen
When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including:
Decreased birth weight in neonates
A woman who is 6 weeks pregnant is concerned because she is nauseated every morning. Which measure should the nurse suggest the patient use to help relieve nausea?
Delay breakfast until midmorning.
A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?
Eat dry crackers or toast before rising
A patient who is 4 months pregnant is experiencing pyrosis. Which suggestion should the nurse make to the patient to help with this health problem?
Eat small meals and do not lie down after meals.
A pregnant patient tells the nurse that drinking enough fluids has always been a problem for her. What should the nurse counsel the patient as being an adequate daily amount of fluid to drink while pregnant?
Eight glasses
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 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 a 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 multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020
The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals?
Heartburn
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
An adolescent who is 8 weeks' pregnant is at her first perinatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?
Intimate partner abuse
A pregnant client in her third trimester is diagnosed with supine hypotension syndrome. What would the nurse instruct the client to do?
Lie laterally, preferably on the left side
A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client?
On her side with the weight of the uterus on the bed
A patient having an examination to check the placement of an intrauterine device (IUD) is diagnosed as being pregnant. For which action should the nurse prepare the patient at this time?
Removal of the IUD
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.
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.
Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman?
Rubella
At a prenatal appointment, a woman who is 3 months pregnant confides to you that she ingests starch because of a craving she has had since adolescence. She is now 26 years old. What would be your most appropriate response?
Suggest she have a hemoglobin done because of the association between pica and iron deficiency anemia.
The nurse is caring for a client with a G=5, T=0, P=3, A=1, L=3 obstetric history. The nurse is most correct to state which interpretation?
The client has had difficulty reaching full term.
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.
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
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.
At midpoint during pregnancy, you review beginning signs of labor with a patient. One of the beginning signs of labor you would review is
a sudden gush of clear fluid from the vagina.
The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?
alpha-fetoprotein analysis
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
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?
clean catch urine
The nurse is discussing nutritional supplementation with a 27-year-old pregnant client. Which element would the nurse encourage as essential in preventing neural tube defects?
folic acid
A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment?
history of diabetes for 4 years
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
A pregnant woman works as a secretary at a large corporation. She states that she wants to take a leave of absence from work for pregnancy but is afraid she will lose seniority standing because of this. You would advise her that
legally, her employer cannot penalize her this way.
Part of the initial prenatal assessment should include the client's immunization history. The nurse informs the client to avoid which type of vaccines while she is pregnant?
live virus vaccine
Which two tests are generally performed on urine at a prenatal visit?
protein and glucose
An adolescent who is pregnant asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe?
swimming
The nurse is assisting a primigravid on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:
the first day of the last menstrual period.
An obviously pregnant woman appears for her first prenatal visit. She reports a headache and generalized abdominal pain which has persisted over the past couple months. Which question should the nurse prioritize after determining the client is approximately 24 weeks' gestation, appears nervous, and is reluctant to have a full physical assessment?
"Do you feel safe at home?"
The nurse is planning a seminar that focuses on the 2020 National Health Goals during pregnancy for patients who are in the first trimester of pregnancy. Which information should the nurse include in this seminar? (Select all that apply.)
- Refusing alcohol -Importance to stop smoking -Maintaining health appointments -Abstaining from drugs and substances
The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply.
-headache with visual changes in the third trimester -sudden leakage of fluid during the second trimester -lower abdominal pain with shoulder pain in the first trimester
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
How should the nurse document a pregnant patient's gestational status using the GTPAL system after collecting the following data? Currently 18 weeks pregnant Patient's fourth pregnancy Delivered one nonviable fetus at 26 weeks Experienced one miscarriage Delivered one viable fetus at 38 weeks' gestation
4, 1, 1, 1, 1
You encourage a pregnant woman to eat a diet high in complete protein. Assuming she likes all of the following foods, which of them would you recommend as a source of this for her?
A boiled or fried egg
Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do?
Alert the RN or primary care provider
A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?
Always wear a three-point seat belt
What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol one to two times a week?
Avoid all alcohol while pregnant.
A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort?
Avoid consumption of caffeinated drinks.
During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam?
Chadwick's sign
While assessing a client's breast during the third trimester, which finding would the nurse expect?
Colostrum from the nipples
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 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
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.
The urine of a woman in her second trimester of pregnancy is found to contain glucose. For which condition should she be tested?
Gestational diabetes
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
A nurse assesses a 32-year-old primigravida client with twin gestation in her second trimester. The client reports constipation from iron supplements. Which condition should the nurse assess for in this client as a result of the constipation?
Hemorrhoids
A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms?
If rhythmical, they could indicate preterm labor.
When explaining what will occur during the first prenatal visit physical examination, a pregnant patient asks why a Papanicolaou smear is being done at this time. What should the nurse respond to the patient?
It detects cancer cells of the cervix, vulva, or vagina.
A woman reports to the clinic to have her IUD checked. During the visit it is determined she is 6 weeks pregnant. How will the presence of the IUD be handled?
It will be removed to allow the pregnancy to grow.
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 pregnant woman who had stress incontinence during a previous pregnancy asks the nurse what could be done to manage this in her current pregnancy. What should the nurse recommend to the client?
Kegel exercises
A pregnant patient is planning travel to a foreign country as part of a work assignment and needs immunizations. What should the nurse instruct the patient about immunizations while pregnant?
Live virus immunizations are contraindicated while pregnant.
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 has identified the diagnosis of imbalanced nutrition for a pregnant patient. Which assessment data did the nurse use to identify this diagnosis for the patient?
Patient does not want to gain any weight while pregnant.
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 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
A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?
Serve the formula at room temperature.
Which of the following would you advise a woman about breast self-examination during pregnancy?
She should choose a date each month to do this.
During a previous prenatal visit, the nurse focused on the importance of adequate nutritional intake with a pregnant patient. Which assessment findings indicate that this teaching has been effective? (Select all that apply.)
Shiny hair Smooth tongue Normal muscle reflexes
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 pregnant patient who works as a secretary at a large corporation wants to take a leave of absence from work but is afraid of losing seniority. What should the nurse advise the patient?
The employer cannot penalize the patient for being pregnant.
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 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
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."
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 pregnant patient has a history of genital herpes lesions and has experienced outbreaks periodically throughout the pregnancy. What should the nurse instruct the patient regarding this virus if lesions are present at the time of delivery?
A cesarean section will be advised at the time of birth.
When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy?
Famotidine
A woman who professes to be a strict vegetarian voices concerns about her ability to meet the nutritional needs of her fetus. Which concerns should be addressed in this session?
The supplementation of Vitamin B12 should be addressed.
