Chapter 11: The Expectant Family: Needs and Care

A 23 year old patient is 10 weeks' gestation with her first pregnancy. She expresses worry over feeling no sexual desire for her husband and asks if this is normal. How should the nurse respond? A. "That sounds normal. In many cases, sexual desire decreases in the first trimester, but it increases again during the second trimester." B. "That's unusual. Usually, there are minimal changes in sexual desire throughout a healthy pregnancy." C. "That sounds normal. During the first trimester, sexual desire often decreases; however, by the third trimester, sexual desire is usually greater than before pregnancy." D. "That's unusual. Throughout a healthy pregnancy, sexual desire usually increases with each trimester."

A. "That sounds normal. In many cases, sexual desire decreases in the first trimester, but it increases again during the second trimester." During the first trimester, factors such as fatigue, nausea, vomiting, and breast tenderness may decrease desire for sexual activity. During the second trimester, as these discomforts lessen and pelvic vascular congestion increases, the woman may experience greater sexual satisfaction than before pregnancy. While each woman may be different, sexual desire often decreases during the first trimester, increases during the second trimester, and then decreases again during the third trimester.

A 43 year old client has just had a positive pregnancy test. She cries and states, "I just don't know what I'll do. I can't be pregnant." Which of the following nursing diagnoses would be the most appropriate? A. Self-esteem disturbance related to advanced maternal age B. Knowledge deficit related to advanced maternal age C. Decisional conflict related to unexpected pregnancy D. Depression related to unexpected pregnancy

C. Decisional conflict related to unexpected pregnancy An unplanned pregnancy at any age is often a life-changing event for the client. Self-esteem can be affected by a pregnancy at this age, as peers might be becoming grandparents, and if the client has other children, they might be nearing adulthood. Women over the age of 35 have a higher incidence of pregnancy complications. Depression can occur, but we do not have enough client data to indicate that this client is depressed. false

A 32 year old primipara who is 8 weeks' gestation asks you if she should expect any respiratory changes as her pregnancy progresses. What should the nurse tell her? A. "By the third trimester, you will no longer feel as though you're short of breath." B. "If you develop shortness of breath, it should improve in the last few weeks of your pregnancy, as lightening occurs." C. "Shortness of breath is an abnormal finding during any stage of pregnancy, and it's considered a serious complication." D. "You may experience shortness of breath due to stretching of the round ligament."

B. "If you develop shortness of breath, it should improve in the last few weeks of your pregnancy, as lightening occurs." The primigravida experiences considerable relief from shortness of breath in the last few weeks of pregnancy, when lightening occurs and the fetus and uterus move down in the pelvis. Shortness of breath occurs as the uterus rises into the abdomen and causes pressure on the diaphragm. This problem worsens in the last trimester. Because of decreased vital capacity from pressure of the enlarging uterus on the diaphragm, shortness of breath is a common problem of pregnancy. Round ligament stretching causes a "grabbing" sensation in the lower abdomen and inguinal area.

The pregnant patient has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question? A. "Birth defects are very rare. Don't worry; your doctor will watch for problems." B. "To be safe, don't take any medication without talking to your doctor." C. "Too much vitamin C is one of the most common issues but is avoidable." D. "Almost all medications will cause birth defects in the first trimester."

B. "To be safe, don't take any medication without talking to your doctor." Teratogens are substances that can cause birth defects. Alcohol is one example, as are warfarin (Coumadin) and isotretinoin (Roaccutane). The greatest risk is during the first trimester, but not all medications are teratogenic. Those medications with clear evidence of teratogenicity are classified in pregnancy category X and should be avoided when conception is being attempted and during the first trimester. The nurse should avoid a "don't worry" answer to ensure therapeutic communication, but it is appropriate to instruct the patient to talk to the doctor about medications. Vitamin C can cause rebound scurvy but is not teratogenic. Not all medications are teratogenic.

A pregnant patient who swims 3-5 times per week asks the nurse if she should stop this activity. What is the appropriate nursing response? A. "You should decrease the number of times you swim per week." B. "You should continue your exercise program because it would be beneficial." C. "You should discontinue your exercise program immediately." D. "You should increase the number of times you swim per week."

B. "You should continue your exercise program because it would be beneficial." Thirty minutes of moderate-intensity exercise daily is recommended for pregnant women, but even mild exercise is helpful. Women who exercise regularly have better muscle tone, self-image, bowel function, energy levels, sleep, and postpartum recovery than do those who are sedentary.

The patient in her first trimester of pregnancy is experiencing nausea. To promote self-care, the nurse should help the pregnant patient understand that the nausea might be relieved by: A. Eating spicy foods B. Not eating until two hours after rising C. Eating small, frequent meals D. Avoiding carbonated beverages

C. Eating small, frequent meals Avoiding severe hunger by eating small, frequent meals throughout the day can help to prevent or decrease the severity of the nausea. The nausea of pregnancy can be exacerbated by ketosis, fatigue, and certain foods, such as those containing caffeine or spices. Eating dry carbohydrates prior to rising each day can help to prevent or decrease the severity of the nausea. Carbonated beverages might be helpful in decreasing nausea.

Upon arriving at the prenatal clinic in the morning, the nurse receives messages from four patients. Which patient complaint should be addressed first? A. Primip at 9 weeks' gestation with increased fatigue and nocturia B. Multip at 30 weeks' gestation with vaginal bleeding after performing yoga C. Primip at 24 weeks' gestation with ankle edema D. Multip at 35 weeks' gestation with new onset of hemorrhoids

B. Multip at 30 weeks' gestation with vaginal bleeding after performing yoga Vaginal bleeding after yoga is a warning sign that should be immediately reported to the primary care provider; this patient is the highest priority for care. Fatigue and increased urination at night is a common pregnancy-related discomfort during the first trimester. Particularly during the second and third trimester, ankle edema is a common pregnancy-related discomfort. Hemorrhoids are a common pregnancy-related discomfort, especially during the second and third trimester.

The nurse is explaining the importance of fetal activity assessment to the patient. What should the nurse do to best reinforce the significance of fetal kick counting to the patient? A. Perform daily phone calls to the patient at work or home B. Review the patient's written record of fetal movement at each visit C. Ask the patient to remember to count the fetal movements D. Explain the rationale for counting fetal movement to the patient

B. Review the patient's written record of fetal movement at each visit Patients should be instructed to begin counting fetal movement between 24 and 28 weeks. A fetus that has been active and has a sudden decrease in movements could be conserving energy due to hypoxia. Movements are counted in a specified time period, such as for one hour after each meal, or beginning with arising in the morning. Daily phone calls would take emphasis away from the importance of the patient's counting of fetal movement. Writing down the count is more accurate than the patient's simply remembering. When the nurse examines the written record the patient has kept, it reinforces the importance of the record and improves the likelihood of continued record keeping. Knowing the reasons for the counting will increase understanding of the process but will not reinforce its significance of the task.

The nurse is preparing a class for expectant fathers. Which information should the nurse include? A. Siblings adjust readily to the new baby B. Sexual activity is safe for normal pregnancy C. The expectant mother decides the feeding method D. Fathers are expected to be involved in labor and birth

B. Sexual activity is safe for normal pregnancy During a normal pregnancy, sexual activity is safe for both mother and baby. Siblings often have difficulty adapting to the arrival of a new baby. Regression is often seen in siblings' behaviors. Often, the father wants input into the feeding method. In some cultures, labor and birth are only for women, and it is inappropriate for fathers to be involved with the labor and birth.

The nurse is teaching an early pregnancy class for patients in the first trimester of pregnancy. Which statement requires immediate intervention by the nurse? A. "When my nausea is bad, I will drink some ginger tea." B. "The fatigue I am experiencing will improve in the second trimester." C. "It is normal for my vaginal discharge to get green-colored." D. "I will urinate less often during the middle of my pregnancy."

C. "It is normal for my vaginal discharge to get green-colored." Leukorrhea is an increase in white vaginal discharge and is an expected finding during pregnancy. Green discharge is not a normal finding and indicates a bacterial infection. The infection can be a sexually transmitted infection or bacterial vaginosis. Further assessment is required for a patient with green vaginal discharge. Ginger helps nausea, and is safe for use during pregnancy. First-trimester fatigue is common; fatigue usually improves during the second trimester. As the uterus rises in the pelvis during the second trimester, urinary frequency decreases. Urinary frequency increases again during the end of the third trimester as the fetal head descends into the pelvis.

The pregnant patient is in her 21st week of pregnancy and is planning a vacation with her family. She asks the nurse which method of travel would be recommended for her to use. How should the nurse respond? "The safest method of travel is to: A. "Take an automobile." B. "Fly on an airplane." C. "Travel by train." D. "Not travel this late in pregnancy."

C. "Travel by train." In the latter half of pregnancy, frequent movement is recommended for pregnant women, both to increase comfort and to decrease venous pooling, which can lead to thrombophlebitis. The train allows the most movement for the traveling pregnant woman. Automobile and airplane travel do not allow for frequent enough movement. It is not necessary to cease travel altogether.

The prenatal patient in her third trimester tells the clinic nurse that she works eight hours a day as a cashier and stands when at work. What response by the nurse is best? A. "No problem. Your baby will be fine." B. "Do you get regular breaks for eating?" C. "Your risk of preterm labor is higher." D. "Standing might increase ankle swelling."

C. "Your risk of preterm labor is higher." Pregnant women who stand for more than five a day have an increased risk of preterm labor. Because preterm labor can put the infant's life at risk, this statement would be the highest priority. Standing more than five hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. Although breaks for eating, drinking, and toileting are important for pregnant employees, it is more important to tell the patient about the increased risk of preterm labor.

A patient in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? A. Point the toes of the affected leg B. Increase intake of protein-rich foods C. Limit activity for several days D. Flex the foot to stretch the calf

D. Flex the foot to stretch the calf Leg cramps are a common problem in pregnancy, resulting from an imbalance in the calcium-phosphorus ratio; pressure on nerves or decreased circulation in the legs from the enlarged uterus; or fatigue. Dorsiflexing the foot will stretch the calf muscles and will help relieve the cramps. Pointing the toes will exacerbate leg cramps. Protein intake does not affect leg cramps. Limiting activity is not appropriate.

A patient who is at 10 weeks' gestation tells her nurse, "I'm making too much saliva, and I spit on people every time I talk! What's wrong with me?" How should the nurse respond? A. "Let's schedule you for a doctor's appointment, because excessive salivation can signal a complication of pregnancy." B. "That's called ptyalism, and it's usually caused by increased salt intake during the second trimester." C. "You should avoid astringent mouthwashes and chewing gum." D. "Excess salivation commonly occurs during the first trimester, although the cause is unknown."

D. "Excess salivation commonly occurs during the first trimester, although the cause is unknown." Ptyalism, which is excess production of saliva, commonly occurs during the first trimester and the cause is unknown. Astringent mouthwashes, chewing gum, and sucking hard candy may help relieve the bitter taste that often accompanies ptyalism.

The nurse is caring for a pregnant patient. The patient's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the adaptation to pregnancy by the father-to-be? A. "What kind of work do you do?" B. "What furniture have you gotten for the baby?" C. "How moody has your wife been lately?" D. "How are you feeling about becoming a father?"

D. "How are you feeling about becoming a father?" The adaptation of a husband to pregnancy includes his feelings about impending fatherhood. What kind of work the husband does is not an indicator of his adaptation. What furniture has been obtained is not an indicator of his adaptation. The husband's perception of his wife's moodiness is not an indicator of his adaptation.