Chapter 12: Nursing Management During Pregnancy

During the health assessment of a pregnant client who is 30 years old, the nurse discusses preventive breast care. Which recommendation would the nurse include?

"A breast examination by a health care provider can help detect if there are any structural problems that may affect breastfeeding." Breast self-examination is no longer thought to yield enough reliable information to be continued as a monthly self-care routine, but women should be alerted to normal breast changes during pregnancy and about the responsibility to begin having mammograms when they reach 40-45 years of age. Clinical breast examination in women of average risk has not been shown to be effective in average risk women at any age. However, it may be helpful in identifying any anatomical issues with breastfeeding that may occur Confirm whether a woman has had a human papillomavirus (HPV) vaccine as many women are not yet aware the vaccine has the potential to not only prevent HPV infections but also prevent cervical cancer; it is not associated with breast cancer, however.

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.

At her 12-week prenatal visit, the primagravida states, "I haven't felt my baby move yet. What is wrong?" What is the best response to the client?

"The fetus kicks regularly, although the pregnant woman usually cannot feel the movements until approximately 16 to 20 weeks."

A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best?

"Your statistical risk of another tubal pregnancy is increased." If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.

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 diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about:

18 to 20 weeks pregnant. There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.

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%

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.

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

Baseline data is collected.

A woman in her 20s explains to the nurse that she would like to eat more healthy foods during her pregnancy but complains about the high cost of food. She confides that she just makes minimum wage at her job and that things are tight for her financially. What would be the most appropriate intervention for the nurse to make?

Discuss the WIC program with the client.

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. Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

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

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 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

A nuse is providing care to a pregnant woman. To promote optimal outcomes, the nurse would engage in which activity? Select all that apply.

Individualized assessment Counseling Teaching Nurses contribute to the success of prenatal care through individualized assessment, counseling, and educating. Assistance with social coordination and authoritarian decision making are not associated with successful prenatal care.

A client is preparing to leave the clinic after her first prenatal visit. What is important for the woman to do before she leaves the office?

Make a follow-up appointment.

A client, 31 years old, at 28 weeks gestation with her second pregnancy is in the clinic for a prenatal check-up. She informs the nurse of frequent low back pain and ankle edema by the end of the day. What interventions should the nurse suggest to relieve these discomforts?

Rest when possible with feet elevated at or above the heart.

What anatomic area should be examined when assessing Montgomery tubercles?

breasts

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?

Wear support hose.

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?

alpha-fetoprotein analysis Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The Doppler flow study evaluates the blood flow, and amniocentesis evaluates the contents of the amniotic fluid looking for chromosomal defects.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?

amniotic fluid volume

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

A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information?

biophysical profile A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detected via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.

Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?

clean catch urine

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 Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tub use.

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

The nurse advises a pregnant woman to reduce her fluid intake with meals. Which condition is the woman trying to relieve or prevent?

heartburn

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus?

near the bottom of the sternum

During the first prenatal visit an extensive history is collected from the client. What is one part of this extensive history?

social history

An adolescent who is pregnant asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe?

swimming

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 Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.

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

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How does the nurse record her obstetric history on the chart using the GTPAL format?

G5 T2 P1 A1 L3 One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for preterm, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation. "L" is for living, the number of children delivered who are alive at the time of history collection.