Ch 12: Nursing Management During Pregnancy

The first day of the client's last menstrual period was December 1. Based on Naegle's rule, the nurse determines that which date is the estimated date of birth? A) September 8 B) October 7 C) July 7 D) August 8

A) September 8 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.

Which nursing intervention is appropriate when preparing a woman for an amniocentesis? A) Suggest that she take a deep breath and hold it during needle insertion. B) Be certain she knows that there are risks of complication, such as premature labor, from amniocentesis. C) Inform her that a narcotic premedication will be given to prevent pain during needle insertion. D) Instruct her not to empty her bladder prior to the procedure.

B) Be certain that she knows that there are risks of complication, such as premature labor, from amniocentesis. Amniocentesis carries a slight risk of beginning labor. The woman should not hold her breath because that depresses the diaphragm, shifts the contour of the uterus, and may shift the location of the placenta to the chosen needle insertion site. The bladder should be emptied to avoid accidental puncture.

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

B) anterior surface of the sacral prominence and the anterior surface of the symphysis pubis The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet.

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? A) increase in fetal kick count B) contractions beginning in the back and sweeping forward across the abdomen C) intermittent backache stronger than usual D) lightening (descent of the fetus into the pelvis)

B) 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.

A pregnant client is asking about medications, supplements, and vaccines. Which would the nurse indicate as potentially teratogenic? A) folic acid B) rubella vaccine C) penicillin D) acetaminophen

B) 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 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? A) "The safest medication to take for your headaches during your pregnancy would be ibuprofen." B) "Wait until you reach your third trimester. You can take something to relieve headaches then." C) "The safest medication to take for your headaches during your pregnancy would be acetaminophen." D) "You don't want to harm the baby by taking medications now, do you?"

C) "The safest medication to take for your headaches during your pregnancy would be acetaminophen." The medication that is approved for treatment of headaches is acetaminophen.

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

C) Eat dry crackers or toast before rising. The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which guideline should the nurse give her? A) Sit in the back seat with feet elevated. B) Limit trips away from home, greater than 200 miles. C) Stop and walk every few hours. D) Travel no more than 120 miles daily.

C) 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.

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? A) Wear low-heeled shoes. B) Wear cotton shoes. C) Wear a padded bra. D) Wear support hose.

D) Wear support hose. The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight.

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? A) pressure of fetal head on the bladder B) engorgement of veins by the weight of the uterus C) relaxation of cardioesophageal sphincter D) pressure on intestine by the growing fetus

D) pressure on intestine by the growing fetus The nurse should explain that constipation often occurs during the third trimester because the growing fetus exerts pressure on the intestine. Engorgement of veins by the weight of the uterus causes varicosities. Pressure of the fetal head on the bladder increases the frequency of urination. Relaxation of the cardioesophageal sphincter causes heartburn.