PrepU: Chapter 12: Nursing Management During Pregnancy

A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? "You only have a few more weeks until the birth and then you will breathe fine again." "Oxygen requirements are increasing in your body because the fetus is growing." "Don't worry about this because it is a normal change that occurs with pregnancy." "The enlarging uterus pushes against your diaphragm and this makes breathing shallow."

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow."

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem? 13.5 cm 12.0 cm 12.5 cm 13.0 cm

12.0 cm

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 13 May 20 April 27 March 13

April 27

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? Drink plenty of fluids at bedtime. Avoid eating spicy food. Avoid foods such as cheese. Eat dry crackers or toast before rising.

Eat dry crackers or toast before rising.

Which information is most important in order to decrease the risk of complications if the client decides to work until her due date? Frequent rest periods Flat shoes Eat light meals Adequate sleep

Frequent rest periods

A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? G2 T2 P1 A0 L2 G2 T1 P1 A1 L1 G3 T2 P2 A0 L1 G3 T0 P1 A1 L2

G3 T0 P1 A1 L2

A primipara woman has been asking about all the minor body changes she has been experiencing over the first 3 months—nausea, fatigue, breast tenderness, constipation, and abdominal discomfort. The clinic nurse responsible for the documentation related to this woman's reports has identified which diagnosis to be the most relevant in this scenario? Health-seeking behaviors Acute distress Ineffective coping Readiness for enhanced comfort

Health-seeking behaviors

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? Impaired urinary elimination related to inability to excrete creatine from her muscles Risk for ineffective breathing pattern related to pressure of the growing uterus Pain related to severe complications of pregnancy Health-seeking behaviors related to ways to relieve discomforts of pregnancy

Health-seeking behaviors related to ways to relieve discomforts of 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 Abnormal bleeding Electrolyte deficiencies Hypothyroidism

Hemolytic anemia

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 21 July 16 July 13 July 19

July 16

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? Relaxing activities such as hot baths and jacuzzis Stretching and breathing exercises such as yoga High-impact movements enabling less time in the activity All activities that the client does in a prepregnant state

Stretching and breathing exercises such as yoga

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. Avoid caffeinated beverages. Take with dairy products. Take only at bedtime.

Take antacid 1 hour after the multivitamin.

The nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results? There is no evidence of congenital anomalies or deformities. The fetal heart rate increases with activity and indicates fetal well-being. The results indicate a stress test is needed for further evaluation. The fetus is developing at a fast rate but doing fine.

The fetal heart rate increases with activity and indicates fetal well-being.

A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem? Avoid overeating. Avoid spicy food. Use extra pillows. Lie on a firmer mattress.

Use extra pillows.

The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure? contraction stress test biophysical profile nonstress test amniocentesis

amniocentesis

During pregnancy, the cardinal rule concerning 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 gastritis cholelithiasis gout

asthma

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? at the level near the bottom of the sternum at the level of the symphysis pubis at the level of the umbilicus three finger-breadths above the umbilicus

at the level of the umbilicus

What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)? breasts abdomen perineum thorax

breasts

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: increased risk of placental abruption (abruptio placentae). decreased birth weight in neonates. increased risk of stillbirth. increased risk of spontaneous abortion (miscarriage).

decreased birth weight in neonates.

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? nosebleeds heartburn constipation blood clots

heartburn

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 exercising twice a week maternal age of 28 years history of occasional use of OTC pain relievers history of diabetes for 4 years

history of diabetes for 4 years

Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman? diphtheria polio rotavirus rubella

rubella

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? bicycling jogging swimming skiing

swimming

The nurse educates the vegetarian client about which nutritional need during pregnancy? supplementing the diet with vitamins A and C limiting the intake of fiber taking a B12 supplement avoiding high intake of dark green vegetables.

taking a B12 supplement

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? lower abdominal and shoulder pain severe, persistent vomiting vaginal bleeding painful urination

vaginal bleeding

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." "I won't expect more than three movements to happen in an hour." "I'll do the count once a week on a morning that I'm not rushed for work." "I'll do the counts while I'm sitting and watching my son's basketball game."

"I'll sit comfortably in a recliner or lie on my side when I do the counts."

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? "If you prepare your own douching solution, be sure to boil the water to kill bacteria." "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." "Douching will definitely keep your vagina clean." "Let's discuss this with your health care provider before you continue douching."

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."

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? "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy." "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." "Sexually transmitted infections are much more common than most people believe." "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully."

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern? "I only want my family to see the baby after it is born." "I am unsure who the father of the baby is. I will be raising it alone." "I am not sure if I want to keep the baby. It is a hard decision." "I needed Rho(D) immune globulin after my last pregnancy. Will I need it again?"

"I am unsure who the father of the baby is. I will be raising it alone."

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement? "I need to cut out caffeine." "I need to raise the head of my bed about 15 to 30 degrees." "I should lie down for 1/2 hour after eating." "I should chew my food slowly."

"I should lie down for 1/2 hour after eating."

At 24 weeks' gestation a client is asked to drink a sweet orange solution and then wait an hour to have blood drawn. The client asks if this is the test to determine if she has diabetes. What is the best response by the nurse? "This is a diagnostic test to identify insulin resistance during pregnancy." "This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes." "Yes. If the results of your blood work are elevated you have gestational diabetes and will be started on insulin." "No, this is part of the routine prenatal lab work. The test for gestational diabetes will be done during your third trimester."

"This is a screening procedure. If your result is elevated you will be scheduled for a longer test to determine if you have gestational diabetes."

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy? "It is safe for you to take over-the-counter medications." "You should switch to herbal remedies because they are safer to use than other types medicines." "You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." "You need to avoid all prescription, over-the-counter, and herbal medications when you are pregnant."

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."

A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse? "You should start to feel fetal movements within the next few weeks." "You usually cannot feel them until approximately 16 to 20 weeks." "Fetal movements can be felt at 13 weeks." "You won't be able to feel movements until you lie down and concentrate on them."

"You usually cannot feel them until approximately 16 to 20 weeks."

A pregnant woman who has come to the clinic for an evaluation is scheduled to undergo nuchal translucency screening. The woman asks the nurse, "What is this test all about?" Which response(s) by the nurse would be appropriate? Select all that apply. "The provider will check the amount of fluid in the space behind your fetus's neck." "A needle is inserted into your belly to get a sample of cells from the placenta." "You will have blood drawn to check for substances associated with abnormalities." "You will have an ultrasound done to check for chromosomal problems." "This test involves an amniocentesis to check for genetic abnormalities."

"You will have an ultrasound done to check for chromosomal problems." "The provider will check the amount of fluid in the space behind your fetus's neck."

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 24 weeks 18 weeks 22 weeks

18 weeks

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 24 cm 32 cm 18 cm 30 cm

24 cm

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, 2, 2, 1, 1 3, 2, 1, 1, 1 3, 2, 1, 2, 1 4, 1, 1, 1, 1

4, 1, 1, 1, 1

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? Activate the air bag in the car. Apply a padded shoulder strap properly. Always wear a three-point seat belt. Use a lap belt that crosses over the uterus.

Always wear a three-point seat belt.

In which situation is the nurse correct to document a reactive nonstress test? Select all that apply. Decelerations in the fetal heart rate every 15 minutes At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip The mother noting fetal movement and/or fetal kicks A lack of fetal movement over a 20 minute period

At least 2 accelerations of the fetal heart rate Variability noted in the fetal monitor strip The mother noting fetal movement and/or fetal kicks

A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy? Client does not have anemia. Client does not have cervical insufficiency. Client does not have anxieties and worries. Client does not experience facial and hand edema.

Client does not have cervical insufficiency.

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? Engage in aerobics for greater benefits. Continue this as long as she enjoys it. Reduce walking to half a block daily. Stop and rest every block.

Continue this as long as she enjoys it.

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? Increase intake of calcium. Perform aerobic exercises. Increase intake of folic acid. Elevate legs while sitting.

Elevate legs while sitting.

When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? interior surface of the sacral prominence and the posterior surface of the symphysis pubis medial surface of the ischial tuberosities posterior surface of sacrum and the axis of the ischial tuberosities anterior surface of the sacral prominence and the anterior surface of the symphysis pubis

anterior surface of the sacral prominence and the anterior surface of the symphysis pubis