Chapter 12: Nursing Management During Pregnancy

A pregnant 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?

"Acetaminophen is considered relatively safe to take for your headaches during your pregnancy."

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?

"At 36 weeks' gestation, the fundus is in the normal expected location."

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy?

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy."

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."

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

"I wear knee-highs rather than pantyhose."

The nurse is providing education regarding fetal kicks/movement to a primigravid client at 22 weeks' gestation. Which client statement indicates an understanding of the teaching?

"I will document how long it takes my baby to move 10 times."

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."

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?

"The gloves they provide irritate my hands, so I don't use them."

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.

"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 diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?

12.0 cm

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect?

28 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, 1, 1, 1, 1

At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1C above which level is concerning for diabetes and warrants further testing?

6.5%

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling

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 pregnant client in the first trimester reports drinking 3 to 4 cups of coffee with cream and sugar daily and is hoping to cut down. What will the nurse advise to improve pregnancy health outcomes?

Attempt to reduce coffee consumption or replace with decaffeinated coffee to reduce caffeine intake.

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.

A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise?

Come to the hospital now for assessment.

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.

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply.

Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating.

A physically fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. The woman normally jogs, but has been thinking about taking up cycling. The woman also would like to know how much exercise is recommended. Which instruction(s) will the nurse give to the woman? Select all that apply.

Exercise for 30 minutes per day 5 days per week. Include warm-up and cool-down exercises. Avoid sports that involve body contact. Avoid taking up a new sport, such as cycling, during pregnancy. Try walking, which is an excellent exercise option during pregnancy.

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.

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 spontaneous abortion (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

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?

G3 T0 P1 A1 L2

The nurse is educating a woman about the importance of folic acid before conception and during pregnancy, to prevent neural tube defects in the fetus. The client plans to take prenatal vitamins and minerals. What food source would the nurse recommend to add to the woman's diet?

Green leafy vegetables

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

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?

Helps the lungs remain expanded after the initiation of breathing

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 17-year-old woman has become pregnant as her boyfriend refused to wear condoms. The boyfriend calls her names, often becomes jealous and, although rare, sometimes hits her. Which condition is this pregnant client most at risk of developing in this pregnancy? Select all that apply.

Placental abruption (abruptio placentae) Small-for-gestational-age infant Preterm birth Sexually transmitted infection

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.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage?

Stretching and breathing exercises such as yoga

The nurse educates the vegetarian client about which nutritional need during pregnancy?

Taking a b12 supplement

While reviewing the medical record of a client, the nurse notes that the client is para 2. What does the nurse know from this information?

The client has had 2 pregnancies reaching viability.

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?

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

The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client?

Walk for 30 minutes 5 days a week.

A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?

at the level of the umbilicus

The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid?

citrus juice

While assessing a client's breast during the third trimester, which finding would the nurse expect?

colostrum from the nipples

A pregnant client in her first trimester visits the health care facility for regular checkups. The nurse instructs the client to increase her dietary intake of folic acid based on the understanding that folic acid is important for which action?

decreasing incidence of birth defects

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

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur?

fetal tachycardia

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

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

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

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

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

A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving the unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman associate with true labor? Select all that apply.

pain in back that wraps across the abdomen and increases in frequency and intensity pink-tinged blood and mucus mixture on underwear

During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy?

prepregnancy BMI

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

Which two tests are generally performed on urine at a prenatal visit?

protein and glucose

A nursing student correctly identifies which action to be the best way to prevent complications of pregnancy?

receiving prenatal care

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?

rubella

Assessment of a pregnant client reveals leukorrhea. Which instruction will the nurse include when teaching the client about how to care for this condition?

showering daily

A pregnant client and family are planning a trip that requires a 7-hour car ride. Which education will the nurse provide about traveling in a car?

stopping at least every 2 hours to walk around

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?

swimming

An athletic woman has just discovered she is 6 to 8 weeks' pregnant. From the list of her usual sports and activities, which activity(ies) should be discussed in further detail since it is contraindicated during pregnancy? Select all that apply.

swimming long distances in triathlons cliff diving playing ice hockey

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?

the use of OTC drugs with teratogens

A pregnant client has come to a health care provider for her first prenatal visit. The nurse needs to document useful information about the past health history. What are goals of the nurse in the history-taking process? Select all that apply.

to prepare a plan of care that suits the client's lifestyle to develop a trusting relationship with the client to prepare a plan of care for the pregnancy

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?

ultrasound equipment