Ricci, Kyle & Carman: Maternity and Pediatric Nursing, Second Edition: Chapter 12: Nursing Management During Pregnancy; PrepU

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 The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

Why is the first prenatal visit usually the longest prenatal visit?

Baseline data is collected. The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

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 pregnant client is asking about medications, supplements, and vaccines. Which would the nurse indicate as potentially teratogenic?

rubella vaccine Most vaccines are contraindicated during pregnancy and are considered teratogenic. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching?

"I wear knee-highs rather than pantyhose." Women with varicosities should not wear knee-high stockings as they put pressure on leg veins and reduce venous return.

A woman accustomed to daily exercise reports late in her second trimester of pregnancy that she is experiencing "terrible" heartburn at night. What should the nurse advise her to do?

Elevate the head of the bed by ten to 30 degrees. Heartburn is a common problem worsening as the pregnancy progresses. The pregnancy hormones relax the lower esophageal sphincter resulting in increase heartburn. Elevation of the head of the bead will help maintain the acid from rising at night, and other nonpharmacologic interventions are available if needed. Exercise does not negatively impact heartburn and should be continued. The pregnant mother should not take any medication that is not prescribed by her primary care provider. Heartburn is not a medical emergency.

The client is 32 weeks pregnant and has been referred for 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. 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.

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.

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. The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications to enable the client to avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion.

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 an incompetent cervix. The nurse should inform the client that sexual activity is permissible during pregnancy unless there is a history of incompetent cervix, vaginal bleeding, placenta previa, risk of preterm labor, multiple gestation, premature rupture of membranes, or presence of any infection. Anemia and facial and hand edema would be contraindications to exercising but not intercourse. Freedom from anxieties and worries contributes to adequate sleep promotion.

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. Health interviewing is always conducted best in a quiet, private setting before examination procedures begin.

A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart?

G5 P3114 G = gravida or the total number of pregnancies, which in this case equals five. P = para is the outcome of the pregnancies in the following order: full term, preterm, abortions, and living as of today. In this case, P3114.

A nurse explains to a pregnant woman the importance of consuming adequate iodine in her diet. Which of the following conditions can a deficiency in iodine lead to?

Goiter Iodine is essential for the thyroid gland to be able to produce thyroxine (which is necessary for overall body metabolism). As thyroid function increases during pregnancy, a woman needs to be certain to ingest more iodine than usual to supply this increased need. If iodine intake is inadequate, hypothyroidism (poorly functioning thyroid gland) and thyroid enlargement (goiter) can occur. The other conditions listed are not associated with iodine deficiency.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs?

Refrain from crossing legs when sitting for long periods. To help the client alleviate varicosities of the legs, the nurse should instruct the client to refrain from crossing her legs when sitting for long periods. The nurse should instruct the client to avoid standing, not sitting, in one position for long periods of time. The nurse should instruct the client to wear support stockings to promote better circulation, though the client should stay away from constrictive stockings and socks. Applying heating pads on the extremities is not reported to alleviate varicosities of the legs.

A woman in her sixth month of pregnancy comes in for her first prenatal examination. She complains today of headache and abdominal pain of several months' duration. She appears somewhat hurried or nervous. What questions would the nurse ask next?

"Do you feel safe at home?" All these questions are important when interviewing a pregnant woman. This picture may make you think of social problems such as domestic violence, substance abuse, or both. Asking more directed questions in these areas may be fruitful.

In light of the high incidence of some illnesses in women, which question is most important to include in a review of systems for a pregnant woman?

"Have you had any urinary tract infections?" Urinary tract infections occur at a greater incidence in pregnant women than in others because stasis of urine occurs because of pressure on the ureters; the trace of glucose often present in urine helps bacteria grow.

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." Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.

A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful?

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.

A pregnant woman enjoys exercising at a local health spa once a week. Which comment would lead the nurse to believe she needs additional health teaching?

"Nothing feels nicer than a hot sauna after exercise." Hyperthermia may be associated with fetal anomalies and should be avoided during pregnancy. Exercise should be limited to low-impact activities.

The nurse assesses the uterine fundus and finds it to be halfway between the symphysis pubis and the umbilicus. The nurse would determine that this corresponds to how many gestational weeks?

16 At 16 weeks' gestation, the fundus is half-way between the symphysis and the umbilicus. At approximately 12 weeks, the fundus is at the top of the symphysis pubis and by 10 weeks the fundus should be at the level of the umbilicus.

The first time the nurse sees a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age?

20 weeks The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:

4 weeks. The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

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. To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. The nurse should instruct the client to deactivate the air bag if possible. The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. The nurse should instruct the client to use a lap belt that crosses over the pelvis below—not over—the uterus.

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 24-hour food intake history is the best method to assess food intake in all individuals.

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. To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.

Which statement is true regarding sexual activity and pregnancy?

Because of pelvic congestion, women may experience increased clitoral sensitivity. Only a few complications of pregnancy such as vaginal bleeding and ruptured membranes limit sexual activity. A partially dilated cervix does not warrant a restriction in sexual activity.

A woman who is 3 months pregnant enjoys a slow, long walk daily. Which action would be most appropriate for her for the remainder of her pregnancy?

Continue this as long as she enjoys it. Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate?

Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate?

Elevate legs while sitting. The nurse should encourage the client to elevate her legs while sitting; this will prevent pooling and engorgement of veins in the lower extremities. Aerobic exercises do not help in preventing varicose veins. Folic acid intake is recommended in the first trimester to prevent congenital abnormalities. Increasing the intake of calcium helps in strengthening bones.

What are the purposes for prenatal care? Select all that apply.

Establish a baseline of present health. Determine the gestational age of the fetus. Monitor for fetal development and maternal well-being. Identify women at risk for complications. The purposes of prenatal care are to establish a baseline of present health; determine the gestational age of the fetus; monitor fetal development and maternal well-being; identify women at risk for complications and minimize the risk of possible complications; and provide time for education about pregnancy, lactation, and newborn care. It is not done to help a clinic financially.

Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy?

Facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

A pregnant client arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks gestation. How will the nurse document her "G" and "L" for her records?

G3 L2 She has had two prior pregnancies and is pregnant now, total "G" = 3; she has twins from a prior pregnancy and one lost child for a total "L" = 2.

A client has been confirmed to be pregnant. She gives a history of two previous full-term normal pregnancies. How will the nurse classify the client's pregnancy history?

G3, P2 Gravida (G) is the total number of pregnancies the client has had, including the present one, and para (P) is the number of babies born at 20 or more weeks of gestation. Since she gives a history of two previous normal deliveries, she is P2 and not P0, P1, or P3. Because she has had a total of three pregnancies including the present one, she is G3 and not G2.

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 Women can relieve stress incontinence to some degree by strengthening the perineal muscles through Kegel exercises.

A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination?

Instruct the client to empty her bladder. When preparing the client for a physical examination, the nurse should instruct the client to empty her bladder; the nurse should then collect the urine sample so that it can be sent for laboratory tests to detect possibilities of a urinary tract infection. The client need not lie down, take deep breaths, or have the family present; however, it is important for the nurse to ensure that the client feels comfortable.

Why is a Papanicolaou smear done at the first prenatal visit?

It identifies abnormal cervical cells. A Pap smear is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.

If a pregnant woman's estimated date of delivery (EDD) is April 23, what was the first day of her last menstrual period (LMP), according to Nagele's rule?

July 16 According to Nagele's rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.

A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply.

Limit consumption of food before bedtime. Sleep in a semi-Fowler's position. Avoid overeating. When caring for a pregnant client with heartburn, the nurse should instruct the client to limit consuming foods before bedtime. The nurse should also instruct the client to sleep in a semi-Fowler's position and to avoid overeating. The nurse need not instruct the client to avoid the use of antacids. On the contrary, antacids are known to be useful for heartburn even during pregnancy, so the nurse need not instruct the client to avoid them. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.

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. The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded.

A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual?

Some women experience orgasm intensely during pregnancy. Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which guideline should the nurse give her?

Stop and walk every few hours. Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant woman who sit for extended periods of time. Limiting mileage, sitting in the back with feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.

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 assessment done because of the association between pica and iron-deficiency anemia. Craving nonfood substances is called pica. This is associated with iron-deficiency anemia.

A 24-year-old pregnant woman reports excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation, but she finds it messy and unpleasant. What should the nurse advise her to do?

Use sanitary pads. Vaginal discharge increases during pregnancy and is a concern for many women. Encourage the client to keep clean and wear sanitary pads as needed. Douching may be dangerous for the mother. STIs are not indicated simply by discharge. Pregnant women should not decrease fluid intake.

One function of the nurse when dealing with a pregnant client is to teach self-care during pregnancy. One of the topics that the nurse provides teaching about is breast care. What does the nurse teach the client about keeping the breasts clean?

Wash the nipples with clean water only. She should use only clean water to wash the nipples. Soap dries the nipples and can lead to cracking.

The nurse should administer Rho(D) immune globulin to the pregnant woman who is Rho(D)-, after which test?

amniocentesis Amniocentesis is an invasive procedure whereby a needle inserted into amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with RhD-negative blood, and she should receive RhoGam after the procedure. The CST, NST, and a biophysical profile are noninvasive tests.

During pregnancy the cardinal rule regarding 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 Treatment, including medications, for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?

at the level of the umbilicus By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks', it nears the bottom of the sternum.

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which location?

at the umbilicus At 20 weeks, the fundus can be palpated at the umbilicus. A fundus of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the fundus is midway between the symphysis pubis and umbilicus. At 36 weeks' gestation, the fundus can be palpated just below the ensiform cartilage.

What anatomic area should be examined when assessing Montgomery tubercles?

breasts Montgomery tubercles are sebaceous glands on the areola of the breasts and are prominent during pregnancy.

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 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.

Leah is 28 weeks pregnant. To prepare her for discomforts that occur during the final trimester of pregnancy, what would the nurse teach her about?

experiencing increased shortness of breath and dyspnea before lightening As the fetus grows inside the mother, there is more pressure on the diaphragm and more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with lightening, when the fetus drops. Eating a well balanced diet, oral hygiene, and exercise should be done throughout the entire pregnancy.

Which finding is most worrisome in a client in her 26th week of pregnancy?

facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

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 Gravida (G) indicates the number of pregnancies. When a nurse calculates the GTPA of a pregnant client, the current pregnancy counts and the three other pregnancies count for a total of four pregnancies. Para (P) indicates the number of pregnancies carried to viable gestational age. This client has had two viable pregnancies so far.

A nurse is educating a pregnant client about physical changes that can occur in pregnancy. Which conditions are associated with physical changes in pregnancy? Select all that apply.

nasal stuffiness and sinus problems thoracic breathing instead of abdominal breathing swollen and tender gums During pregnancy, the respiratory system changes to increase lung volume for the fetus. This change can increase estrogen and cause nasal congestion and sensitive, swollen gums. When the fetus is growing, the thoracic muscles and cartilage relax more, and breathing becomes thoracic as the chest broadens. Persistent cough and Kussmaul respirations are not related to pregnancy.

Based on the incidence of disease in women, which assessment of lower extremities would be most important to make in a pregnant woman?

presence of varicosities During pregnancy, women are prone to develop varicosities because of uterine pressure on lower-extremity veins.

A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will move the same amount every day. The nurse adds that if the client notices an unusual increase or decrease in movement, this is a sign of what?

response to a need for oxygen A fetus normally moves more or less the same amount every day. If there is an unusual increase or decrease in movement, the client should be examined because such a change suggests that the fetus is responding to a need for oxygen.

The nurse correctly identifies "gravida 3, para 2" as which definition?

two previous pregnancies, two children born at term, and currently pregnant A woman who has had two previous pregnancies, given birth to two term children, and is pregnant again is gravida 3, para 2.

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." Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.

A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as:

30111. The woman's obstetric history would be documented as 30111, G (gravida) = 3 (current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability) = 1, and L (number of living children) = 1.

A client presents to the office for her obstetric history. She tells the nurse she has 4 children living at home. One child was born at 34 weeks, another child at 37 weeks, two were born consecutively at 38 and 39 weeks, and one was aborted. Record the client's obstetric record using the GTPAL format.

G5, T2, P2, A1, L4 "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or induced (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).

A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance?

More consistent regulation of glucose and insulin Advise women to obtain their carbohydrate calories from complex carbohydrates (cereals and grains) rather than simple carbohydrates (sugar and fruits) because complex carbohydrates are more slowly digested. Doing so will help regulate glucose and insulin levels more consistently. All carbohydrates contain roughly the same amount of calories per gram (4 kcal/g). Carbohydrates of any kind are not a significant source of fatty acids.

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 True labor contractions usually begin in the back and sweep forward across the abdomen similar to tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. Lightening and intermittent backache are preliminary signs of labor but do not indicate true labor. Increase in fetal kick count does not indicate true labor.

During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. The nurse would develop a plan of care identifying interventions to promote which area as the priority?

gas exchange Typically, heart rate increases by approximately 10 to 15 beats per minute during pregnancy and the lungs should be clear. Dyspnea may occur during the third trimester as the enlarging uterus presses on the diaphragm. However, the findings described indicate that the woman is experiencing impaired gas exchange. There is no evidence to support problems with tissue perfusion, activity, or anxiety.

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 Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.