Chapter 12: Nursing Management During Pregnancy

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? A.) 18 cm B.) 24 cm C.) 30 cm D.) 32 cm

Answer: B.) 24 cm

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? A.) Yogurt and low-fat milk B.) Green leafy vegetables C.) Oily fish such as salmon D.) Green and iced tea

Answer: B.) Green leafy vegetables Rationale: Green leafy vegetables are a good source of folic acid. In the past, green tea was thought to interfere with the absorption of folic acid; however, studies do not support this. The women would be advised to avoid green and iced tea due to the caffeine content. Yogurt, low-fat milk and oily fish are not known to be high in folic acid.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? A.) at the level of the symphysis pubis B.) at the level of the umbilicus C.) at the level near the bottom of the sternum D.) three finger-breadths above the umbilicus

Answer: B.) at the level of the umbilicus

To prevent exposure to hepatitis A virus, the nurse teaches the pregnant client to avoid which food? A.) raw fish B.) raw eggs C.) undercooked chicken D.) grilled tuna

Answer A.) raw fish

Depletion of which nutrient during the first trimester makes the fetus susceptible to neural tube defects? A.) folic acid B.) iron C.) potassium D.) thiamine

Answer; A.) folic acid

During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? A.) prepregnancy BMI B.) current weight C.) height and bone structure D.) hemoglobin level

Answer; A.) prepregnancy BMI

The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? A.) Caution about the opioid premedication. B.) Be certain she is aware of potential complications. C.) Ensure she understands the need for 2 days of bed rest. D.) Expect test results within 1 week.

Answer: B.) Be certain she is aware of potential complications.

The nurse is conducting a prenatal class for a group of primigravida clients. Which instruction will the nurse prioritize when teaching about breast care? A.) Use hot water and a mild soap to keep the nipples clean. B.) Wash the nipples with a deodorant soap to keep them clean and help toughen them. C.) Use an antibacterial soap and cool water to keep the nipples clean. D.) Wash the nipples with clean water only.

Answer: D.) Wash the nipples with clean water only. Rationale: She should use only clean water to wash the nipples. The use of any soap will dry the nipples and can lead to cracking.

Why is a Papanicolaou test done at the first prenatal visit? A.) It predicts whether cervical cancer will occur. B.) It helps to date the pregnancy. C.) It detects if uterine cancer is present. D.) It identifies abnormal cervical cells.

ANSWER: D.) It identifies abnormal cervical cells.

A pregnant client has come to a health care facility for a physical examination. Which assessments should a nurse perform when doing a physical examination of the head and neck? Select all that apply. - previous injuries and sequelae - eye movements - levels of estrogen - limitations in range of motion - thyroid gland enlargement

Answer: - previous injuries and sequelae - limitations in range of motion - thyroid gland enlargement Rationale: While conducting a physical examination of the head and neck, the nurse assesses for any previous injuries and sequelae, evaluates for limitations in range of motion, and palpates the thyroid gland for enlargement. The nurse should also assess for any edema of the nasal mucosa or hypertrophy of gingival tissue, as well as palpate for enlarged lymph nodes or swelling. The nurse need not check the client's eye movements; pregnancy does not affect the eye muscles. The nurse should check for levels of estrogen when examining the extremities of the client.

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? A.) "I should substitute intercourse with nonsexual touch to avoid harming the fetus." B.) "I will experience a heightened need for touch throughout my pregnancy." C.) "If I experience bleeding, I will abstain from vaginal intercourse." D.) "I will avoid having intercourse following the rupture of the membranes."

Answer: A.) "I should substitute intercourse with nonsexual touch to avoid harming the fetus."

The nurse is conducting a comprehensive initial assessment of a pregnant client during a prenatal visit. When assessing the client's social history, what questions should the nurse include? Select all that apply. - "What do you currently do for employment?" - "Do you currently use tobacco?" - "Who do you have in your life who can support you?" - "Have you ever been hospitalized?" - "Do you have any chronic health problems?"

Answer: - "What do you currently do for employment?" - "Do you currently use tobacco?" - "Who do you have in your life who can support you?"

A client at 10 weeks' gestation is complaining of ptyalism over the past 2 weeks. What intervention would the nurse recommend to this client? Select all that apply. - Chew gum. - Use saline nasal spray. - Wear a panty liner. - Eat a large, protein rich meal in the evening. - Suck on hard candies.

Answer: - Chew gum. - Suck on hard candies. Rationale; Ptyalism or excess salivation may be relieved by chewing gum or sucking on hard candies. Many of the interventions used to relieve nausea and vomiting may also work for ptyalism.

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestion(s) by the nurse is helpful? Select all that apply. - Limit fluid intake to 1 liter daily. - Complete moderate exercise daily. - Wear compression stockings. - Keep legs below the level of the heart. - Avoid sudden position changes.

Answer: - Complete moderate exercise daily. - Wear compression stockings.

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply. - Limit fluid intake to 1 liter daily. - Complete moderate exercise daily. - Wear compression stockings. - Keep legs below the level of the heart. - Avoid sudden position changes.

Answer: - Complete moderate exercise daily. - Wear compression stockings.

At her prenatal visit a client reports that she cannot find any shoes that are comfortable. Assessment of her legs reveals dependent edema. The nurse suggests that the client attempt which actions to help reduce the edema? Select all that apply. - Elevate feet and legs when sitting or lying. - Avoid foods high in sodium, sugar, and fats. - Drink 6 to 8 glasses of water each day. - Wear knee-high support stockings. - When lying down, lie on the right side.

Answer: - Elevate feet and legs when sitting or lying. - Avoid foods high in sodium, sugar, and fats. - Drink 6 to 8 glasses of water each day. Rationale: Dependent edema is usually the result of pressure put on the veins preventing adequate blood flow to return to the heart. Appropriate suggestions to reduce dependent edema include elevating feet and legs when sitting or lying down; avoiding foods that are high in sodium, sugar, and fats; drinking at least 6 to 8 glasses of water per day; avoid wearing knee-high stockings; and lying on the left side to keep the gravid uterus off the vena cava to return blood to the heart.

A nurse is conducting a program about the importance of prenatal care for a group of women in a community health clinic. Which information would the nurse include when describing the purpose of 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. - Maximize the risk of possible complications. - Identify women at risk for complications. - Increase the business of the clinic.

Answer: - 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.

A nurse is providing care to a pregnant client at 9 weeks' gestation. The client reports that her breasts have become quite tender. She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply. - estrogen - oxytocin - progesterone - prolactin - hCG

Answer: - estrogen - progesterone Rationale: An increase in estrogen and progesterone that occurs with pregnancy causes the fat layer of the breasts to thicken and the number of milk ducts and glands to increase during the first trimester. Oxytocin stimulates uterine contractions. Prolactin stimulates breast milk production. hCG is the hormone that confirms pregnancy.

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 - urinary frequency in the third trimester - sudden leakage of fluid during the second trimester - nausea with vomiting during the first trimester - lower abdominal pain with shoulder pain in the first trimester - backache during the second trimester

Answer: - 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 Rationale: Danger signs and symptoms that need to be reported immediately include headache with visual changes in the third trimester; 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.

The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse? A.) "I am glad I can have my two cups of coffee in the morning again." B.) "I will continue to take a prenatal multivitamin as long as I am breastfeeding." C.) "I will continue to add about 300 calories per day to my diet." D.) "I will drink a large glass of water each time I nurse my baby."

Answer: A.) "I am glad I can have my two cups of coffee in the morning again." Rationale: Breastfeeding mothers should avoid caffeine because it delays iron absorption and passes through the milk and can slow infant weight gain. Similarly, spicy foods pass into the breastmilk and can affect the baby. Breastfeeding mothers need added calories and fluids.

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? A.) "If my AFP level is high, it could mean there is a problem with my baby's spinal cord." B.) "If my AFP level is negative, it means the baby has no birth defects." C.) "If my AFP level is low, then I won't need to follow up." D.) "If there is a need to get my AFP level tested, a blood sample will be obtained around 11 weeks."

Answer: A.) "If my AFP level is high, it could mean there is a problem with my baby's spinal cord." Rationale: 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 client who is 28 weeks' pregnant asks the nurse if it is safe to use mineral oil to relieve constipation. What is the best response by the nurse? A.) "No, mineral oil may interfere with the absorption of fat-soluble vitamins from your diet." B.) "No, mineral oil may initiate premature labor and birth." C.) "Yes, mineral oil will enhance the absorption of water soluble vitamins from the diet." D.) "Yes, mineral oil may increase the bulk of the feces and prevent constipation."

Answer: A.) "No, mineral oil may interfere with the absorption of fat-soluble vitamins from your diet." Rationale: Mineral oil should be avoided because it interferes with the absorption of fat soluble vitamins that are needed by the fetus. It does not alter the absorption of water soluble vitamins, change the bulk of the stool, or cause preterm labor.

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: A.) 18 to 20 weeks' pregnant. B.) 15 to 17 weeks' pregnant. C.) 21 to 23 weeks' pregnant. D.) 24 to 26 weeks' pregnant.

Answer: A.) 18 to 20 weeks' pregnant. Rationale: 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.

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: A.) 4 weeks. B.) 3 weeks. C.) 2 weeks. D.) 1 week.

Answer: A.) 4 weeks.

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? A.) 6.5% B.) 6.0% C.) 5.5% D.) 5.0%

Answer: A.) 6.5%

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? A.) Client does not have cervical insufficiency. B.) Client does not have anxieties and worries. C.) Client does not have anemia. D.) Client does not experience facial and hand edema.

Answer: A.) Client does not have cervical insufficiency. Rationale: The nurse should inform the client that sexual activity is permissible during pregnancy unless there is a history of cervical insufficiency, 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.

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? A.) Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. B.) Watch the diet so no additional weight is gained during this pregnancy. C.) Limit weight gain to less than 5 lb (2 kg) for the remainder of this pregnancy. D.) Increase weight gain to 1.5 lb (0.68 kg) per week during this pregnancy.

Answer: A.) Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Rationale: Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.

A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? A.) Eat fiber-rich foods. B.) Take a fiber-based laxative. C.) Use a water-based enema. D.) Insert a glycerin suppository.

Answer: A.) Eat fiber-rich foods.

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? A.) G3 P0020 B.) G2 P0020 C.) G2 P1020 D.) G3 P0021

Answer: A.) G3 P0020 Rationale: Gravida (G) is the total number of pregnancies she has had, including the present one. Therefore she is G3 and not G2. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today. She has no living children; therefore, it is 0 and not 1.

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse? A.) The steroids speed up the development of the lungs. B.) The steroids will help to slow the development of infection. C.) The steroids will increase the baby's muscle mass. D.) The steroids will create a layer of fat to help with temperature regulation.

Answer: A.) The steroids speed up the development of the lungs. Rationale: Steroids given to the mother before birth help to speed up the development of the fetal lungs. The use of prenatal steroids has decreased the mortality rate in preterm infants. Prenatal steroids do not increase muscle mass or amount of fat tissue to aid in temperature regulation. Prenatal steroids do not have an impact on the development of sepsis in either the mother or neonate.

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client? A.) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. B.) Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus. C.) Long soaks in very hot water are encouraged during pregnancy to promote relaxation. D.) Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus.

Answer: A.) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. Rationale: Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? A.) amniotic fluid volume B.) fetal heart rate C.) fetal breathing record D.) fetal reactivity

Answer: A.) amniotic fluid volume Rationale: A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? A.) at 28 weeks B.) at 32 weeks C.) at 36 weeks D.) only at birth

Answer: A.) at 28 weeks

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? A.) biophysical profile B.) chromosomal abnormalities C.) the effectiveness of neural tube defect treatment D.) the size and shape of placenta

Answer: A.) biophysical profile Rationale: 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.

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

Answer: A.) contractions beginning in the back and sweeping forward across the abdomen Rationale: 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 woman asks the nurse if she can take an over-the-counter vitamin during pregnancy rather than her prescription prenatal vitamin. A chief ingredient in prenatal vitamins that makes them important for pregnancy nutrition is: A.) folic acid. B.) vitamin B12. C.) vitamin C. D.) potassium.

Answer: A.) folic acid.

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus? A.) neurological challenges B.) cataracts C.) fetal growth restriction D.) spontaneous abortion

Answer: A.) neurological challenges Rationale: Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions (miscarriages). Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider? A.) vaginal bleeding B.) painful urination C.) severe, persistent vomiting D.) lower abdominal and shoulder pain

Answer: A.) vaginal bleeding

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement? A.) "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy." B.) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." C.) "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully." D.) "Sexually transmitted infections are much more common than most people believe."

Answer: B.) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them."

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? A.) "I'll try to drink more fluids to help move things along." B.) "I'll switch to chewing gum instead of using mints." C.) "I'll stay away from foods like cabbage and brussels sprouts." D.) "I'll increase my time spent on walking each day."

Answer: B.) "I'll switch to chewing gum instead of using mints." Rationale: 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.

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? A.) "I only work four hours a day so I don't get exposed too much." B.) "The gloves they provide irritate my hands, so I don't use them." C.) "There hasn't been a chemical spill in three years." D.) "I have an assistant helping me now to handle the chemicals."

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

Why is the first prenatal visit usually the longest prenatal visit? A.) Laboratory tests are performed. B.) Baseline data is collected. C.) A pelvic exam with Papanicolaou test is performed. D.) Extensive client teaching is done.

Answer: B.) Baseline data is collected.

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: A.) G = 4, T = 2, P = 0, A = 0, L = 1 B.) G = 3, T = 1, P = 0, A = 1, L = 1 C.) G = 1, T = 1, P = 1, A = 0, L = 1 D.) G = 2, T = 0, P = 0, A = 0, L = 1

Answer: B.) G = 3, T = 1, P = 0, A = 1, L = 1 Rationale: The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility? A.) Hypothyroidism B.) Hemolytic anemia C.) Electrolyte deficiencies D.) Abnormal bleeding

Answer: B.) Hemolytic anemia Rationale: Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.

Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client? A.) Inform the client that she may feel hot initially. B.) Instruct the client to refrain from emptying her bladder. C.) Instruct the client to report the occurrence of fever. D.) Obtain and record vital signs of the client.

Answer: B.) Instruct the client to refrain from emptying her bladder. Rationale: When assessing fetal well-being through abdominal ultrasonography, the nurse should instruct the client to refrain from emptying her bladder. The nurse must ensure that abdominal ultrasonography is conducted on a full bladder and should inform the client that she is likely to feel cold, not hot, initially in the test. The nurse should obtain the client's vital records and instruct the client to report the occurrence of fever when the client has to undergo amniocentesis, not ultrasonography.

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? A.) July 13 B.) July 16 C.) July 19 D.) July 21

Answer: B.) July 16 Rationale: According to Naegele 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 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? A.) Avoid sitting in one position for long periods of time. B.) Refrain from crossing legs when sitting for long periods. C.) Apply heating pads on the extremities. D.) Refrain from wearing any kind of stockings.

Answer: B.) Refrain from crossing legs when sitting for long periods. Rationale: 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 client at 29 weeks' gestation tells the nurse she is experiencing aches in her hips and joints. What would the nurse do next? A.) Have the primary health care provider see the client. B.) Tell the client these are normal findings during pregnancy. C.) Ask the client if there is a family history of arthritis. D.) Document these findings in the client's chart.

Answer: B.) Tell the client these are normal findings during pregnancy. Rationale: The hormone relaxin causes the smooth muscles, joints, and ligaments of the body to relax. Because of the production of relaxin during pregnancy, women often experience aches in the pelvic area. The nurse would explain to the client this is a normal finding of pregnancy and will resolve. The nurse should document this in the chart, but it is not priority over educating the client.

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? A.) There is no evidence of congenital anomalies or deformities. B.) The fetal heart rate increases with activity and indicates fetal well-being. C.) The fetus is developing at a fast rate but doing fine. D.) The results indicate a stress test is needed for further evaluation.

Answer: B.) The fetal heart rate increases with activity and indicates fetal well-being. Rationale: A nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity, and this indicates fetal well-being. This test is not used to determine congenital anomalies or deformities. It does not determine the speed by which fetus is developing. Further evaluation would be necessary if the results were nonreactive.

Some pregnant women hire a trained professional to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who takes this role? A.) partera B.) doula C.) midwife D.) pregnancy aide

Answer: B.) doula Rationale: The pregnant woman may hire a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment? A.) history of exercising twice a week B.) history of diabetes for 4 years C.) history of occasional use of OTC pain relievers D.) maternal age of 28 years

Answer: B.) history of diabetes for 4 years Rationale: A diagnosis of diabetes in a pregnant client increases risk for both the client and the infant during pregnancy and requires close monitoring and follow-up. This client's age, exercise history, and history of occasional OTC pain reliever use do not increase pregnancy risk.

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? A.) drinking liquids with meals B.) limiting intake of heavy, greasy foods C.) increasing fluid intake D.) limiting carbohydrate intake

Answer: B.) limiting intake of heavy, greasy foods

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? A.) "You don't want to harm the baby by taking medications now, do you?" B.) "Wait until you reach your third trimester. You can take something to relieve headaches then." C.) "Acetaminophen is considered relatively safe to take for your headaches during your pregnancy." D.) "Ibuprofen is considered safe to take for your headaches during your pregnancy."

Answer: C.) "Acetaminophen is considered relatively safe to take for your headaches during your pregnancy." Rationale: The medication that is approved for the treatment of headaches in pregnant women is acetaminophen. Acetaminophen is considered relatively safe to take during pregnancy.

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy? A.) "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." B.) "Smoking during pregnancy places your baby at an increased risk of intellectual disability." C.) "Babies of women who smoke tend to weigh significantly less than other infants." D.) "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

Answer: C.) "Babies of women who smoke tend to weigh significantly less than other infants." Rationale: Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, intellectual disability, or nicotine dependence.

A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse? A.) "Fetal movements can be felt at 13 weeks." B.) "You should start to feel fetal movements within the next few weeks." C.) "You usually cannot feel them until approximately 16 to 20 weeks." D.) "You won't be able to feel movements until you lie down and concentrate on them."

Answer: C.) "You usually cannot feel them until approximately 16 to 20 weeks." Rationale: The first fetal movements felt by the pregnant woman are usually felt between 16 and 20 weeks gestation. Thirteen weeks is too early (fetus is too small), and movements cannot be felt even if the woman lies down and concentrates on them, although the woman should start feeling movements within the next few weeks.

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect? A.) 12 cm B.) 18 cm C.) 28 cm D.) 32 cm

Answer: C.) 28 cm

A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this? A.) Take a teaspoon of baking soda before breakfast. B.) Delay toothbrushing until noon. C.) Delay breakfast until mid-morning. D.) Take two aspirin on arising.

Answer: C.) Delay breakfast until mid-morning. Rationale; The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

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? A.) G2 T2 P1 A0 L2 B.) G2 T1 P1 A1 L1 C.) G3 T0 P1 A1 L2 D.) G3 T2 P2 A0 L1

Answer: C.) G3 T0 P1 A1 L2 Rationale: G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide? A.) Mix one scoop of powder with an ounce of water. B.) Feed the infant every 8 hours. C.) Serve the formula at room temperature. D.) Refrigerate any leftover formula.

Answer: C.) Serve the formula at room temperature. Rationale: 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.

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement? A.) Avoid caffeinated beverages. B.) Take only at bedtime. C.) Take antacid 1 hour after the multivitamin. D.) Take with dairy products.

Answer: C.) Take antacid 1 hour after the multivitamin. Rationale: Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.

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? A.) at the top of the symphysis pubis B.) halfway between the symphysis pubis and the umbilicus C.) at the level of the umbilicus D.) at the xiphoid process

Answer: C.) at the level of the umbilicus Rationale: In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

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? A.) once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth B.) once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth C.) once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth D.) once every 4 weeks for the first 36 weeks, then weekly until the birth

Answer: C.) once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Rationale: The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching? A.) "I maintain a high fluid intake." B.) "I'll try not to stand for long periods." C.) "I dorsiflex my feet and ankles frequently." D.) "I wear knee-highs rather than pantyhose."

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

Following an initial prenatal visit, a woman's rubella titer results were less than 1:8. On her next visit, the woman asks what this test result means. Which is the best answer to this woman's question about her rubella titer results? A.) "You have immunity against rubella." B.) "You recently were infected with rubella." C.) "You were exposed to someone with rubella." D.) "You are susceptible to a rubella viral invasion."

Answer: D.) "You are susceptible to a rubella viral invasion." Rationale: A titer of less than 1:8 suggests a woman is susceptible to viral invasion. A titer greater than 1:8 suggests immunity to the disease. A titer that is greatly increased over a previous reading or is initially extremely high suggests a recent infection has occurred.

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

Answer: D.) Eat dry crackers or toast before rising. Rationale: 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 nurse caring for a client in labor has asked her to perform Lamaze breathing techniques to avoid pain. Which should the nurse keep in mind to promote effective Lamaze-method breathing? A.) Ensure deep abdominopelvic breathing. B.) Ensure abdominal breathing during contractions. C.) Ensure client's concentration on pleasurable sensations. D.) Remain quiet during client's period of imagery.

Answer: D.) Remain quiet during client's period of imagery. Rationale: According to the Lamaze method of preparing for labor and birth, the nurse must remain quiet during the client's period of imagery and focal point visualization to avoid breaking her concentration. The nurse should ensure deep abdominopelvic breathing by the client according to the Bradley method, along with ensuring the client's concentration on pleasurable sensations. The Bradley method emphasizes the pleasurable sensations of birth and involves teaching women to concentrate on these sensations when "turning on" to their own bodies. The nurse should ensure abdominal breathing during contractions when using the Dick-Read method.

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? A.) Perform nipple exercises and stimulation on a regular basis. B.) Take a hot water bath or shower daily to maintain hygiene. C.) Apply lanolin ointment to the nipple and areola to prevent cracking. D.) Rest on the left side for at least 1 hour in the morning and afternoon.

Answer: D.) Rest on the left side for at least 1 hour in the morning and afternoon. Rationale: During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.

A 31-year-old client at 28 weeks' gestation reports frequent low back pain and ankle edema by the end of the day. Which suggestion should the nurse prioritize for this client? A.) Soak feet every night and perform pelvic rocks. B.) Lie on right side with feet elevated and a heating pad on the back. C.) Take breaks at work and sit in a semi-Fowler position with feet below. D.) Rest when possible with feet elevated at or above the heart.

Answer: D.) Rest when possible with feet elevated at or above the heart. Rationale: Resting in the recumbent position helps alleviate stress on the back, and elevating the legs will help relieve the edema. Soaking the feet or lying on the right side will not alleviate the edema. Sitting semi-Fowler is not enough to alleviate the edema.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? A.) All activities that the client does in a prepregnant state B.) Relaxing activities such as hot baths and jacuzzis C.) High-impact movements enabling less time in the activity D.) Stretching and breathing exercises such as yoga

Answer: D.) Stretching and breathing exercises such as yoga

The client is 32 weeks' pregnant and has been referred for a 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? A.) The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. B.) The BPP is a blood test to detect placental problems. C.) The BPP is a screening for neural tube defects. D.) The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

Answer: D.) The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. Rationale: 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.

Which possible complication associated with back pain can lead to premature contractions? A.) increased intracranial pressure B.) leak of spinal fluid into the epidural space C.) herniated disc D.) bladder or kidney infection

Answer: D.) bladder or kidney infection Rationale: Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. Increased ICP, spinal fluid leak, and a herniated disc are usually not associated with back pain during a normal pregnancy.

The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? A.) heartburn B.) faintness C.) slowed GI transit time D.) nausea and vomiting

Answer: D.) nausea and vomiting Rationale: Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which immunization is most relevant to ensuring a healthy fetus? A.) rubella B.) hepatitis A and B C.) measles D.) diphtheria, tetanus, and pertussis

Answer; A.) rubella

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready? A.) ultrasound equipment B.) sterile field with scalpel C.) Foley catheter D.) sterile urine cup

Answer; A.) ultrasound equipment

A 25-year-old client at 27 weeks' gestation reports waking up with leg cramps. Which suggestion should the nurse point out to the client to help relieve this discomfort? A.) Use plantar flexion exercises three times every day. B.) Dorsiflex the foot while extending her leg during the cramp. C.) Encourage her to drink more fluids, 10 glasses a day. D.) Avoid any supplementation of vitamins or minerals.

Answer; B.) Dorsiflex the foot while extending her leg during the cramp. Rationale: Plantar flexion can make cramps worse, so dorsiflexion while extending the leg can relieve the cramp; excess fluid and lack of supplementation with vitamins or minerals may worsen cramps. Performing plantar flexion exercise does not prevent the cramp. Increasing fluids may help, but has never proven to eliminate cramping.

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? A.) October 7 B.) September 8 C.) July 7 D.) August 8

Answer; B.) September 8

The nurse is caring for a client having chorionic villus sampling using the transcervical approach. When preparing the client for the procedure, in which position is the client placed? A.) supine position B.) recumbent position C.) Sims position D.) lithotomy position

Answer; D.) lithotomy position

A woman comes to the clinic for an exam and says that she is considering trying to become pregnant in the next few months. What would the nurse encourage the client to begin taking now? A.) iron B.) folic acid C.) calcium D.) magnesium

Answer: B.) folic acid

Which two tests are generally performed on urine at a prenatal visit? A.) protein and sodium B.) pH and glucose C.) occult blood and protein D.) protein and glucose

Answer: D.) protein and glucose