Chapter 4 - Physiological Aspects of Antepartum Care

Using Naegele's Rule, calculate the estimated due date (EDD) if the woman's last menstrual period (LMP) was June 11.

March 11 Correct Feedback Using Naegele's Rule, subtract 3 months and add 7 days to the LMP.

A mother who had a stillbirth 2 months ago stated that she has been trying to get pregnant. The nurse determines that she may be at risk for iron-deficiency anemia. Which advice would the nurse give to this woman? 1. "Take iron supplements." 2. "Continue taking megadoses of vitamins and minerals." 3. "Increase your intake of calcium and magnesium." 4. "Take Folic acid 0.6mg once per day."

Answer: 1 Option 1: Taking iron supplements will replace the iron stores she lost in the recent pregnancy. Option 2: Taking megadoses of vitamins and minerals may be toxic to the anticipated pregnancy. Option 3: Taking calcium and magnesium contributes to bone health, and does not reduce the risk for iron-deficiency anemia. Option 4: Taking Folic acid 0.6mg once per day reduces the risk for neural tube defects, not iron- deficiency anemia.

The nurse is educating a 34-week gestation client about danger signs to report to her health care provider. Which symptom would be added to the nursing care? 1. Blurry vision or seeing "floaters" 2. Edema in her feet and ankles after being on her feet at work 3. Frequent urination 4. Occasional nausea and vomiting

Answer: 1 Option 1: Visual changes can be indicative of hypertensive disorders and should be reported to the health care provider. Option 2: Dependent edema is common in the third trimester due to the pressure of the fetus slowing venous return from the lower half of the body. Option 3: Urinary frequency (with the absence of pain or urgency) reappears in the third trimester due to increasing weight of the fetus and lightening. Option 4: Occasional nausea and vomiting is unlikely to cause significant dehydration or nutritional deficits. Prolonged nausea and vomiting should be reported.

A client in her second trimester presented at the clinic with a history of vaginal bleeding. She has no history of trauma. Which condition in the client's history would assist the nurse to determine the cause for the bleeding? Select all that apply. 1. Friable cervix 2. Placenta previa 3. Urinary frequency 4. Hyperemesis gravidarum 5. Absence of fetal movement

Answer: 1,2 Option 1: Vaginal bleeding may indicate a friable cervix. Option 2: Vaginal bleeding may indicate placenta previa. Option 3: Urinary frequency is an indication of a urinary tract infection. Option 4: Prolonged nausea and vomiting indicates possible hyperemesis gravidarum. Option 5: Absence of fetal movement may be an indication of fetal distress.

During a prenatal appointment, the nurse assesses the client's blood pressure and obtains a reading of 152/94 mmHg. The nurse should assess for which additional symptoms? Select all that apply. 1. Facial edema 2. Dyspnea 3. Vision changes 4. Severe headache 5. Pelvic pressure

Answer: 1,3,4 Option 1: Facial and generalized edema are likely present in clients with hypertensive disorders. Option 2: Difficulty breathing is not likely associated with hypertensive disorders. Option 3: Hypertensive disorders may cause swelling and pressure on the optic nerve resulting in visual changes Option 4: Headache not relieved by usual measure (such as acetaminophen) are associated with hypertensive disorders. Option 5: Pelvic pressure would be present in a patient who could be experiencing preterm labor. It is not associated with increased blood pressure.

A client states to the nurse, "This is my fourth pregnancy. Do I really need to have all these appointments?" Which is the most appropriate response by the nurse? 1. "I'm sure you are very busy with your other children." 2. "Early and regular prenatal care can catch problems early and reduce complications." 3. "Do you need assistance with transportation or have financial concerns?" 4. "Of course. Skipping appointments will jeopardize the health of you and your baby."

Answer: 2 Option 1: The nurse acknowledges the client's situation, but this response does not answer her question. Option 2: This is a factual response that answers the client's question regarding why she does need to receive prenatal care. Option 3: Transportation and finances can be a barrier to receiving prenatal care and should be addressed. However, this response does not answer the client's question. Option 4: This response by the nurse is non-therapeutic. It assumes the client would willingly place herself or child in danger.

A client states, "I think I might be pregnant. My period is late and I've been feeling really nauseous." Which would be the best response by the nurse? 1. "That's great! I am so happy for you." 2. "These are presumptive signs of pregnancy. You could be pregnant." 3. "These are positive signs of pregnancy. You are absolutely pregnant." 4. "You should schedule an appointment to make sure you do not have an ectopic pregnancy."

Answer: 2 Option 1: The symptoms reported by the client do not confirm pregnancy. It is also unknown how the client feels about this situation. Option 2: Amenorrhea and nausea are presumptive signs of pregnancy (subjective signs experienced by the patient). Option 3: Positive signs of pregnancy include auscultating fetal heart tones or observing the fetus on an ultrasound. Option 4: The symptoms reported do not confirm pregnancy, nor do they support diagnosis of possible ectopic pregnancy, which could include abdominal pain and vaginal bleeding.

The nurse is teaching a pregnant client about positioning to avoid supine hypotensive syndrome. Which positioning would be effective? 1. Elevate her feet while she is sitting. 2. Dangle her feet over the edge of the bed for 30 seconds before getting up. 3. Sleep in a side-lying position. 4. Place a pillow under her knees while she is in bed.

Answer: 3 Option 1: Elevation of the feet will help with dependent edema, but not supine hypotension. Option 2: Sitting on the edge of the bed before rising would help with orthostatic hypotension, but not supine hypotension. Option 3: Sleeping in a side-lying position displaces the uterus so that it does not compress the vena cava. Option 4: This may help increase the client's general comfort, but does not affect the positioning of the uterus. A pillow placed under one side of her hip would be beneficial.

During prenatal appointments, the nurse provides teaching to the client. When providing teaching, which action would the nurse include? 1. Provide teaching about all procedures the client will need in one sitting. 2. Avoid teaching to the family to assure client privacy. 3. Assess the client's understanding of teaching. 4. Inform the client that if she has questions, they can be answered at the next visit.

Answer: 3 Option 1: Teaching about procedures can be provided as needed. Teaching everything at once can be overwhelming for the client. Option 2: Providing teaching to significant support persons is an important aspect of family-centered care. Option 3: Following teaching, the nurse should assess the client's level of understanding and clarify items if needed. Option 4: Adequate time should be given during the appointment to allow for client questions.

A woman visits the clinic and stated that she has missed four menstrual periods and remains unsure whether or not she is pregnant. The nurse informs her that a ballottement test will be done to diagnose whether or not she is pregnant. How can a ballottement test assist the nurse in confirming a pregnancy? 1. By using a transvaginal ultrasound the nurse will be able to visualize the gestational sac. 2. By detecting the presence of the human chorionic gonadotropin in the urine sample in a laboratory. 3. By detecting the presence of the human chorionic gonadotropin in the blood sample in a laboratory. 4. By tapping on the cervix the fetus will rise in the amniotic fluid and then rebound to its original position.

Answer: 4 Option 1: Transvaginal ultrasound involves using a vaginal probe to visualize the gestational sac as early as 5- weeks gestation. Option 2: Doing a laboratory test can detect human chorionic gonadotropin in the maternal urine. Option 3: Doing a laboratory test can detect human chorionic gonadotropin in the maternal blood. Option 4: Tapping on the cervix causes the fetus to rise in the amniotic fluid, and then rebound to its original position.

A nurse is attending to two pregnant clients. The first client was assessed as "early term." The second was assessed as "full term." In order for the nurse to make such assessments, how mature are the clients' pregnancies? 1. The first client is between 37 0/7 weeks and 38 6/7 weeks. The second client is between 39 0/7 weeks and 40 6/7 weeks. 2. The first client is between 41 0/7 weeks and 41 6/7 weeks. The second client is between 42 0/7 weeks and beyond. 3. The first client is between 39 0/7 weeks and 40 6/7 weeks. The second client is between 37 0/7 weeks and 38 6/7 weeks. 4. The first client is between 42 0/7 weeks and beyond. The second client is between 41 0/7 weeks and 41 6/7 weeks.

Answer: 1 Option 1: A client who is between 37 0/7 and 38 6/7 weeks gestation is classified as early term. A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. Option 2: A client who is between 41 0/7 and 41 6/7 weeks gestation is classified as late term. A client who is between 42 0/7 weeks gestation and beyond is classified as post term. Option 3: A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. A client between 37 0/7 and 38 6/7 weeks gestation is classified as early term. Option 4: A client who is between 42 0/7 weeks gestation and beyond is classified as post term. A client who is between 41 0/7 weeks and 41 6/7 weeks gestation is classified as late term.

The nurse is preparing to measure a client's fundal height. which would the nurse do to obtain the most accurate measurement? 1. Instruct the client to empty her bladder. 2. Place the measuring tape just below the umbilicus. 3. Use the millimeter markings on the measuring tape to record fundal height. 4. Instruct the client to take a deep breath and hold it during the measurement.

Answer: 1 Option 1: A full bladder may falsely increase the fundal height measurement. By having the client empty her bladder, the nurse can obtain the most accurate measurement. Option 2: To obtain fundal height, the nurse should put the zero point of the tape on the symphysis pubis. Option 3: Fundal height is measured using a centimeter measuring tape. Option 4: Maternal respiration does not alter the fundal height measurement. The mother should breathe normally during the examination.

To avoid supine hypotensive syndrome while measuring fundal height, where would a nurse position a pillow under a client? 1. Head 2. Hip 3. Feet 4. Knees

Answer: 2 Option 1: The client must remain supine while having a fundal height measurement. The pillow cannot go under her head to elevate her. Option 2: The client must remain supine while having a fundal height measurement. To displace the uterus, a pillow should be placed under her hip. Option 3: The client must remain supine while having a fundal height measurement. The pillow cannot go under her feet to elevate her Option 4: The client must remain supine while having a fundal height measurement. The pillow cannot go under her knees to elevate her.

At her 14-week prenatal appointment, the client reports experiencing a moderate amount of white vaginal discharge. Which teaching would the nurse provide? 1. Wear a panty-liner and change it often. 2. Use a vaginal douche to cleanse the vagina of discharge. 3. Change the type of bath soap she is using. 4. Explain that the loss of the mucus plug is normal.

Answer: 1 Option 1: An increase of estrogen during pregnancy causes leukorrhea. The client can wear a panty-liner to keep her undergarments dry. It should be changed regularly to prevent bacterial growth. Option 2: Douching is not recommended during pregnancy, as it alters vaginal pH. Vaginal pH during pregnancy is naturally more acidic to prevent bacterial growth. Option 3: While some women are sensitive to soaps with lots of dye or perfumes, it should not cause vaginal discharge. Option 4: The loss of the mucus plug is a sign of impending labor. This is not a normal occurrence at 14 weeks gestation.

A nurse is caring for a 16-week pregnant client whose obstetrical history includes 5-year-old twins born at 38 weeks gestation and an abortion at 24-weeks after the twins were born. How would the nurse document the client's obstetrical status? 1. G3P2 2. G3P3 3. G2P3 4. G3P4

Answer: 1 Option 1: Client has 3 pregnancies, a term delivery of twins counted as 1 para and an abortion at 24-weeks counted as another para. Gravida and Para (G/P) is a two-digit system to denote pregnancy and birth history. While Gravida refers to the total number of times a woman has been pregnant, Para refers to the number of births after 20-week gestation whether live or stillbirth. Option 2: Client has 3 pregnancies, a term delivery of twins counted as 1 para and a stillbirth at 24-weeks counted as another para. The current pregnancy is not counted until delivery after 20 weeks of gestation. Option 3: Client has 3 pregnancies not two. The current pregnancy, the twins, and the stillbirth delivery. Option 4: Client is para 2 not 4. Current pregnancy is not counted, the twins are counted as 1 para plus the stillbirth delivery at 24-weeks.

A pregnant client at term visits the clinic and tells the nurse that she is feeling tired all the time. A review of her laboratory results show that her hematocrit level is low. The nurse documented "Fatigue" in the client's health records. Which recommendations by the nurse is correct? 1. "Eat iron-rich foods, ask for assistance from family, and get adequate rest." 2. "Wear loose fitting clothes, elevate legs when sitting, and position yourself on your side when lying." 3. "Maintain adequate hydration, rise slowly from sitting to standing, and avoid lying on your back." 4. "Avoid lying on your back, keep your feet moving when standing, and avoid standing for prolonged periods."

Answer: 1 Option 1: Eating iron-rich foods, asking for assistance from family, and getting adequate rest are relief measures for a pregnant client who is fatigued. Option 2: Wearing loose fitting clothes, elevating legs when sitting, and lying on the side are relief measures for a pregnant client with dependent edema in the lower extremities. Option 3: Maintaining adequate hydration, rising slowly from sitting to standing, and avoiding lying on dorsal are relief measures for a pregnant client who has headaches and syncope. Option 4: Avoid lying on dorsal, keeping moving when standing, and avoiding standing for prolonged periods are relief measures for a pregnant client who has orthostatic hypotension.

A pregnant client with four living children, one preterm infant, and one abortion visits the clinic. How is the nurse expected to record the client's data? 1. G 6 T 3 P 1 A 1 L 4 2. G 5 T 2 P 1 A 1 L 4 3. G 4 T 4 P 1 A 1 L 4 4. G 3 T 1 P 1 A 1 L 4

Answer: 1 Option 1: G 6 T 3 P 1 A 1 L 4 means that this is the sixth pregnancy; three infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 2: G 5 T 2 P 1 A 1 L 4 means that this is the fifth pregnancy; two infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 3: T 4 G 4 P 1 A 1 L 4 means that this is the fourth pregnancy; four infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive. Option 4: G 3 T 1 P 1 A 1 L 4 means that this is the third pregnancy; one infant was born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive

A nurse reads the client's history and physical, which lists the GTPAL as 3-1-1-0-2. How would the nurse interpret this? 1. The client has been pregnant three times, delivered once at term, once at preterm, and has two living children. 2. The client has been pregnant three times, delivered once at term, once at preterm, and had one miscarriage. She now has two living children. 3. The client has been pregnant three times, had one set of twins, one delivery after 20 weeks, and two children are living. 4. The client has been pregnant three times, had one therapeutic abortion, one delivery after 20 weeks, no miscarriages, and two living children.

Answer: 1 Option 1: Gravidity refers to the number of times the woman has been pregnant. Term deliveries (which include early, full, late, and post term gestations) are counted under "T." Preterm deliveries are counted under "P." The "A" stands for abortion, which includes therapeutic/induced and spontaneous. The "L" includes living children. Option 2: According to the GTPAL, the client has had no miscarriages. This would be denoted under the "A" category, which states zero. Option 3: The "T" and "P" in GTPAL stand for term and preterm, not twins and para. Option 4: The "T" in GTPAL stands for term. If the client had an abortion, it would be denoted under the "A" column.

During a physical examination, the nurse observed that a client in her late pregnancy has hemorrhoids and varicosities in her legs. Which statement by the nurse explains the cause for these two conditions in a pregnant client? 1. "Increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava." 2. "Increased action of adrenocorticosteroids leads to cutaneous elastic tissues becoming fragile." 3. "The stretching of the abdominal muscle, due to the enlarging uterus." 4. "Increased plasma fibrin by 40% and the fibrinogen by 50%."

Answer: 1 Option 1: Hemorrhoids and varicosities occur as a result of increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava. Option 2: Striae gravidarum occurs as a result of the increased action of adrenocorticosteroids, which leads to the cutaneous elastic tissues becoming fragile. Option 3: Diastasis recti occurs due to the stretching of the abdominal muscle as a result of the enlarging uterus. Option 4: Hypercoagulability occurs due to an increase of plasma fibrin by 40% and the fibrinogen by 50%.

The nurse obtains a fundal height measurement of 32 cm on a client experiencing a healthy, low-risk pregnancy. How does the nurse interpret this measurement? 1. The client is approximately 32-week gestation. 2. The weight of the fetus is approximately 3200 grams. 3. The amniotic fluid volume is 3.2 cm. 4. The distance from the fundus to the xiphoid process is 32 cm.

Answer: 1 Option 1: In a normally growing singleton pregnancy, the fundal height in centimeters should be approximately the same as the gestational age in weeks, give or take 2 weeks. Option 2: Fetal weight cannot be determined through fundal height measurement. A gross estimate can be determined by ultrasound. Option 3: An accurate determination of amniotic fluid volume is obtained through ultrasound imaging, not fundal height measurement. Option 4: Fundal height is measured as the distance from the symphysis pubis to the top of the fundus.

A multiparous client asks the nurse what she can do to help with leaking urine when she coughs or sneezes. Which intervention would the nurse recommend? 1. Perform Kegel exercises 2. See a urology specialist for surgery 3. Empty her bladder every hour 4. Obtain a specimen for urinalysis

Answer: 1 Option 1: Kegel exercises promote pelvic floor muscle strength and decrease the risk of urinary incontinence. Option 2: Urine leaking in a multiparous client is a common problem. Simple, less invasive interventions, such as Kegel exercises, should be encouraged before surgical intervention Option 3: Urinating hourly would be inconvenient to the client. Small amounts of urine contained in the bladder may still leak if pelvic floor muscles are weak. Option 4: Symptoms of urinary tract infection include frequency, urgency, and pain while urinating. These symptoms were not included in the question stem.

The nurse is educating a 32-weeks-pregnant client on how to perform kick counts. Which statement by the client would indicate a need for further teaching? 1. "I will perform the kick counts at a different time every day." 2. "I should call my doctor right away if the baby is not moving as much as usual." 3. "It is normal for the baby to move about 10 times or more in 2 hours." 4. "A kick, flutter, or roll counts as movements."

Answer: 1 Option 1: Kick counts should be performed at the same time every day. Option 2: Decreased or absent fetal movement is a sign of hypoxia and should be reported immediately. Option 3: Feeling 10 movements or more in 2 hours is considered reassuring. Option 4: Kicks, flutters, swishes, and rolls are all considered types of fetal movement that should be counted by the mother.

The nurse is providing preconception counseling to a client. Which topic is most important to educate the client on at this time? 1. Adequate intake of folic acid 2. Common discomforts of pregnancy 3. Infant safety at home 4. Gaining an appropriate amount of weight during pregnancy

Answer: 1 Option 1: Preconception nutrition counseling is important at this time because nutritional deficits at the beginning of pregnancy can affect the development of the fetus. Inadequate folic acid has been linked to an increased risk of neural tube defects. Option 2: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in her early prenatal care. Option 3: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in the second or third trimester. Option 4: The client is seeking preconception counseling and is not yet pregnant. Ensuring she has a healthy BMI before pregnancy would be important, but weight gain during pregnancy can be discussed later.

The nurse is planning care for a group of clients. Which client would need to receive Rho (D) Immune Globulin (RhoGAM)? 1. A client whose blood type is O-negative 2. A client whose white blood cell count was below normal 3. A client with an autoimmune disorder 4. A client whose blood type is O-positive

Answer: 1 Option 1: RhoGAM is given to women who have Rh-negative blood to prevent isoimmunization. Option 2: RhoGAM does not increase white blood cell count or provide immunity to disease. Option 3: RhoGAM does not provide immunity to disease or alter the symptoms of an autoimmune disorder. Option 4: RhoGAM is not needed in women with Rh-positive blood. There are no Rh-antibodies to perceive the fetus as foreign tissue.

A woman visits the clinic and states that she has missed four menstrual periods and is unsure if she is pregnant. The nurse informs her that a ballottement test will be done to diagnose pregnancy. How can a ballottement test assist the nurse in confirming a pregnancy? 1. Softening of the cervix and vagina 2. Softening of the lower uterine segment 3. Brownish pigmentation over the client's forehead 4. Bluish-purplish coloration of the vaginal mucosa 5. A dark line that runs from the umbilicus to the pubis

Answer: 1,2,4 Option 1: Goodell's sign is the softening of the cervix and vagina, which are probable signs that may not be obvious to the woman. Option 2: Hegar's sign is the softening of the lower uterine segment, and is a probable sign that may not be obvious to the woman. Option 3: Brownish pigmentation over the client's forehead is a probable sign that the woman would have observed. Option 4: Chadwick's sign is the bluish-purplish coloration of the vaginal mucosa that can be seen by the nurse, and not the woman. Option 5: Linea nigra is the dark line that runs from the umbilicus to the pubis, and is a probable sign that the woman would have observed.

A couple that recently emigrated from another country visited the prenatal clinic for the first time. The nurses decided to conduct a cultural assessment of the couple. Which assessment by the nurse could assist in planning a culture-specific prenatal care for this couple? Select all that apply. 1. The couple's expectation of the health care system 2. The couple's need for one-on-one prenatal care 3. The couple's beliefs relating to pregnancy 4. History of intimate partner violence 5. A review of systems

Answer: 1,3 Option 1: Assessing the couple's expectations of the health care system allows the nurse to plan culture-specific care. Option 2: Joining a small group will provide a sense of community instead of a one-on-one prenatal care for this couple. Option 3: Assessing the couple's beliefs relating to pregnancy allows the nurse to plan culture- specific care. Option 4: All women should be assessed for intimate partner violence regardless of their nationality. Option 5: The nurse should conduct a review of systems for all women visiting the clinic for the first time.

In the clinic, the nurse is discussing the recommendations for standard precaution against Zika virus infection. Which advice by the nurse will help clients avoid exposure to the virus? 1. "Sleep under mosquito nets since the Aedes albopictus mosquitos only bite at night." 2. "Avoid going to communities that have active mosquito transmission of the virus." 3. "The Zika virus may cause negative pregnancy so remember to take your vaccination by the seventh week of your pregnancy." 4. "It is unnecessary to use protection with an infected spouse."

Answer: 2 Option 1: The Aedes albopictus mosquitos bite at night as well as during the daytime. Option 2: The Zika virus has may have negative pregnancy outcomes. Therefore, pregnant women should avoid going to communities that have active mosquito transmission of the virus. Option 3: There is no vaccine to prevent the Zika virus. Option 4: Using a condom with an infected spouse is a standard precaution against infection.

A pregnant woman asked the nurse why her home is being assessed for the Aedes albopictus mosquitoes. The nurse responded by saying, "I intentionally assessed your home because you are pregnant." Which other reason given by the nurse is correct? Select all that apply. 1. "Your spouse has the Zika virus and can transmit it to you during sexual intercourse." 2. "You have been non-compliant with the vaccination to prevent Zika virus infection." 3. "You have been reporting fever, rash, headache, and muscle pain for the past week." 4. "We do not want the Zika virus to increase the growth of your baby too much." 5. "The Zika virus is an infection that is spread by infected Aedes albopictus mosquitos."

Answer: 1,3,5 Option 1: The Zika virus can be sexually transmitted from an infected partner. Option 2: There is no vaccine to prevent the Zika virus. Option 3: Some symptoms of the Zika virus are fever, rash, headache, and muscle pain. These symptoms can last up to a week. Option 4: The Zika virus impairs fetal growth. Option 5: The Zika virus is an infection spread by infected Aedes albopictus mosquitos.

The nurse will be focusing on 'self-care' during a preconception counseling session with women who are seeking to get pregnant. Which advice should the nurse include in the counseling session? Select all that apply. 1. Discontinue the use of herbal supplements before pregnancy. 2. Avoid aerobic and regular weight-bearing exercise before pregnancy. 3. Continue with the same megadoses of vitamins and minerals as prescribed. 4. Ensure that smoke alarms and carbon monoxide detectors are in working order. 5. Maintain optimal oral health and treat any periodontal disease before pregnancy.

Answer: 1,4,5 Option 1: Using herbal supplements is contraindicated during pregnancy. Option 2: Aerobic and regular weight-bearing exercise provide overall body conditioning, help with weight management and can enhance psychological well-being. Option 3: Megadoses of vitamins and minerals may be toxic to the developing fetus. Option 4: Ensuring that smoke alarms and carbon monoxide detectors are in working order is important for safety reasons. Option 5: Maintaining optimal oral health and treating any periodontal disease before pregnancy may prevent preterm birth.

A woman who is planning to get pregnant started 0.4 mg/day of folic acid. She visited her primary physician and the dose was later increased to 0.8 mg/day because she had an infant with neural tube defect (NTD). The stock volume for folic acid is 0.4 mg. The nurse is expected to instruct the woman to take _____ tablets per day? Fill in the blank.

Answer: 2 Correct Feedback The nurse would have to calculate the number of tablets the client should take: 0.8 mg ÷ 0.4 mg x 1 = 2 tablets per day.

The nurse is admitting a client whose blood type is A-negative and had a miscarriage at 5-weeks gestation. which is the appropriate nursing intervention? 1. Prepare the client for a dilation and curettage (D&C) 2. Administer Rho (D) Immune Globulin (RhoGAM) 3. Instruct the client to use contraception for the next 6 months 4. Perform an ultrasound to confirm all products of conception have been expelled

Answer: 2 Option 1: A D&C is performed when products of conception remain inside the uterus. This information was not included in the question stem. Option 2: Rho (D) Immune Globulin is administered to Rh-negative women with likely exposure to Rh-positive blood such as with pregnancy loss. Option 3: Health care providers typically encourage the client to wait for 2-3 normal menstrual cycles before trying to conceive following a pregnancy loss. Option 4: Performing an ultrasound is not within the nurse's scope of practice. This would be done by a physician/midwife or radiological technician.

A 19-year-old primigravida client's initial prenatal laboratory results show that she has Rh negative blood. Which action by the nurse is correct? 1. Provide antiretroviral therapy during pregnancy and around the time of delivery. 2. Rescreen the client in the second trimester and give RhoGAM at 28-weeks. 3. Monitor for signs and symptoms of anemia and give the client iron supplements. 4. Request a cytology screening every 3 years.

Answer: 2 Option 1: Antiretroviral therapy during pregnancy and around the time of delivery is for clients who are HIV positive. Option 2: Rescreening the client in second trimester and giving RhoGAM will prevent isoimmunization if the baby's blood is Rh positive. Option 3: Monitoring for signs and symptoms of anemia is done for clients whose Hgb blood volume increases more than their red cell volume, and if so, iron supplements should be given. Option 4: Requesting cytology screening every 3 years is done to assess change in the cervical cells.

The nurse is obtaining a 24-hour diet history from a pregnant client. which food consumed by the client would indicate the need for further teaching by the nurse? 1. Pasteurized milk 2. Alfalfa sprouts 3. Cheddar cheese 4. A cup of coffee

Answer: 2 Option 1: Pasteurized milk is safe to drink. Unpasteurized dairy products should be avoided due to bacterial contamination. Option 2: Raw sprouts of any kind should be avoided during pregnancy. Option 3: Cheddar cheese is safe to eat. Soft cheese, such as brie, camembert, or feta should be avoided. Option 4: Pregnant women should limit caffeine intake to 200mg per day, which is approximately one cup of coffee.

The nurse used Naegele's rule to calculate the expected date of delivery (EDD) for a primigravida whose last menstrual period (LMP) was September 7. How did the nurse arrive at June 14? 1. The nurse subtracted 3 months from September 7 and then added 14 days. 2. The nurse subtracted 3 months from September 7 and then added 7 days. 3. The nurse added 3 months to September 7 and then subtracted 14 days. 4. The nurse added 3 months to September 7 and then subtracted 7 days

Answer: 2 Option 1: Subtracting 3 months from September 7 and then adding 14 days would calculate the EDD to be June 21. Option 2: Using Naegele's rule, the correct calculation to calculate the EDD of June 14 is to subtract 3 months from September 7 and then add 7 days. Option 3: Adding 3 months to September 7 and then subtracting 14 days would calculate the EDD to be November 23. Option 4: Adding 3 months to September 7 and then subtracting 7 days would calculate the EDD to be November 30.

An immigrant from Asia who has being living in the shelter for more than a month visits the prenatal clinic. Which laboratory screening would the nurse consider to be priority for this client? 1. Tay-Sachs 2. Tuberculosis skin test 3. Hepatitis B surface antigen 4. Cystic fibrosis carrier screening

Answer: 2 Option 1: Tay-Sachs would be a consideration for persons of eastern European Jewish ancestry. Option 2: Tuberculosis skin test is used for clients at risk, such as recent immigrants and those living in group homes. Option 3: Hepatitis B surface antigen is a consideration to identify women whose infants need immunoprophylaxis post-delivery. Option 4: Cystic fibrosis carrier screening is mainly a consideration for Caucasians.

A spouse calls the birthing center stating that his wife who is 36 weeks gestation is going into premature labor. Which data from the spouse would assist the nurse in determining that premature labor is imminent? Select all that apply. 1. "Her headache is not responding to the medication." 2. "She is having abdominal cramps every 6 minutes." 3. "She is having low back pain with pelvic pressure." 4. "Her bag of membranes has just ruptured." 5. "She has generalized edema."

Answer: 2,3,4 Option 1: Severe headache that does not respond to usual relief measures is a symptom of hypertensive disorder. Option 2: Rhythmic lower abdominal cramping means that labor is imminent. Option 3: Low back pain with pelvic pressure is a symptom of preterm labor. Option 4: Leaking of amniotic fluid is a sign that the client is going into preterm labor. Option 5: Generalized edema is a sign of hypertensive disorder.

The nurse is admitting a client who is 10-weeks pregnant. An ultrasound has been scheduled and the client asks the nurse why this test is necessary. which are the appropriate responses from the nurse? Select all that apply. 1. "To determine the sex of your baby." 2. "To verify your gestational age." 3. "To make sure the baby has a strong heartbeat." 4. "To make sure the baby is inside your uterus and not in the fallopian tube." 5. "To see if you are carrying more than one baby."

Answer: 2,3,4,5 Option 1: External genitalia are not developed enough at 10-week gestation to determine infant sex via ultrasound Option 2: First trimester ultrasound can be used to verify gestational age along with last menstrual period. Option 3: First trimester ultrasound can be used to determine viability Option 4: First trimester ultrasound can be used to identify ectopic pregnancies Option 5: Multifetal gestation can be identified in the first trimester via ultrasound.

The nurse educator is teaching a class of pregnant teenagers about the importance of receiving regular prenatal care. which are the maingoals of prenatal care that the nurse would include in the teaching? Select all that apply. 1. To complete a one-time assessment of health risk status of the pregnancy 2. To provide referrals to resources 3. To maintain maternal fetal health 4. To build rapport with the physician and nursing staff 5. To determine the gestational age of the fetus

Answer: 2,3,5 Option 1: Prenatal care is an ongoing assessment of risk factors and risk-appropriate interventions. It is not a one-time visit. Option 2: Referrals to appropriate resources may be implemented during prenatal care visits. Option 3: Ongoing assessment throughout the pregnancy helps identify abnormalities early. Early intervention improves health outcomes for mother and infant. Option 4: A goal of prenatal care is to build rapport with the patient and her family. Option 5: Prenatal care helps determine accurate gestational age. This is important in monitoring the growth and development of the fetus as well as guiding teaching during the pregnancy.

A student nurse in developing a plan of care documented, "Altered pattern of elimination" for a pregnant client who complained of not having regular bowel movements. Which nursing action by the student nurse is appropriate for the client to resume regular bowel patterns? Select all that apply. 1. Advise the client to avoid high-fat and spicy food. 2. Assist the client to establish regular time for bowel movement. 3. Suggest the client eat small, frequent meals instead of large meals. 4. Encourage the client to eat high-fiber foods and fresh vegetables. 5. Discuss with the client prior strategies used successfully to relieve constipation.

Answer: 2,4,5, Option 1: Advising the client to avoid high-fat and spicy food will decrease nausea and vomiting. Option 2: Establishing a regular time for bowel movement will help the client to resume regular bowel patterns. Option 3: Suggesting to the client they eat small, frequent meals, instead of large meals, will decrease nausea and vomiting. Option 4: Encourage the client to eat high-fiber foods and fresh vegetables to resume regular bowel patterns. Option 5: Discussing prior strategies used successfully to relieve constipation with the client will help to resume regular bowel patterns.

After completing a physical examination of a pregnant women, the nurse states, "You are definitely pregnant." Which positive finding would have prompted the nurse to make that statement? 1. An enlarged abdomen 2. Hyperpigmentation of the skin 3. The palpation of fetal movement 4. An increase in the vascularity of the breasts

Answer: 3 Option 1: An enlarged abdomen is a probable sign of pregnancy. Option 2: Hyperpigmentation of the skin is a probable sign of pregnancy. Option 3: The palpation of fetal movement is a positive sign of pregnancy. Option 4: An increase in the vascularity of the breasts is a presumptive sign of pregnancy.

A client asks the nurse about the importance of preconception counseling. In responding, the nurse states that preconception counseling helps women lessen risky behaviors and eliminate exposure to harmful substances. Which statement made by the nurse about contraception cessation would be included in the preconception counseling? 1. "Women taking contraception up to a month before pregnancy will be better able to conceive and date the pregnancy." 2. "Women using hormonal contraception need to discontinue its use at least one menstrual period before conception." 3. "It may take several months or up to a year to conceive after discontinuing Depo-Provera." 4. "Women using an intrauterine device (IUD) will have it removed during labor."

Answer: 3 Option 1: Continuing with contraception a month before pregnancy is not safe and will not aid in facilitating conception and dating the pregnancy. Option 2: Women using hormonal contraception need to discontinue its use few months instead of a month before conception. Option 3: It may take a woman several months or up to a year to conceive after discontinuing Depo-Provera. Option 4: An intrauterine device (IUD) should be removed before the woman becomes pregnant.

A pregnant woman calls the clinic in a panic, stating that she is packing to leave her partner who has just assaulted her. Which is the most appropriate response by the nurse? 1. "Have you taken out a restraining order as you were advised to do?" 2. "What have you done for your partner to do this to you?" 3. "Call the police and consider alerting your neighbor." 4. "I will have to document this new development."

Answer: 3 Option 1: Educating her on taking out a restraining order is best practice for patient care, but is not the most appropriate response by the nurse in this present situation. Option 2: The nurse should articulate her belief in the woman so the woman knows the abuse is not her fault. Option 3: Safety is a priority, especially when the woman decided to leave the abusive relationship. Option 4: Documenting in order to accurately capture and record the nature of the injuries is important, but can be done after the woman's safety has been assured.

A nurse is providing prenatal education to a group of primigravida clients with gestational diabetes. Which is the nurse's best explanation for increased maternal insulin needed during the second trimester? 1. "Placental hormone human chorionic gonadotropin (hCG) causes maternal insulin resistant." 2. "Placental hormone progesterone causes maternal insulin resistant." 3. "Placental hormone human chorionic somatomammotropin (hCS) causes maternal insulin resistant." 4. "Placental hormone oxytocin causes maternal insulin resistant."

Answer: 3 Option 1: Placental hormone hCG does not cause maternal insulin resistant. It is detected by a pregnancy test, maintains corpus luteum until placenta becomes fully functional. Option 2: Placental hormone progesterone does not cause maternal insulin resistant. It maintains pregnancy by relaxation of smooth muscles leading to decreased uterine activity. Option 3: Placental hormone hCS produced in the second trimester facilitates fetal growth by acting as an insulin antagonist thereby altering maternal glucose metabolism. Option 4: Oxytocin is a posterior pituitary hormone. It stimulates uterine contraction.

A client from a shelter for battered woman stated, "It is my fault, as I should have not stayed in the situation for so long." Which statement by the nurse is the best response? 1. "Did you alert your neighbors to call the police?" 2. "Tell your partner that you will be taking out a restraining order." 3. "The abuse was not your fault. No one deserves to be mistreated." 4. "Whether or not you give me consent, I will be reporting this to the police."

Answer: 3 Option 1: The shelter can be a lifesaving community resource; therefore, she is not in any immediate danger. Option 2: A restraining order is a lifesaving resource, and telling her partner will jeopardize her safety. Option 3: The nurse is to articulate her belief in the woman by reassuring her that the abuse was not her fault and she does not deserve to be mistreated. Option 4: Reporting the abuse to the police without the woman's consent is a breach of confidentiality.

The urine culture of a client who is at 36 weeks gestation revealed a urinary tract infection. The client's medical records also show that this is the third occurrence since the onset of pregnancy. which advice should the nurse give her on preventing a reoccurrence? Select all that apply. 1. "It is time that you explore different sexual positions." 2. "Practice doing Kegel exercises while urinating." 3. "Urinate immediately before and after sexual intercourse." 4. "Wipe from back to front after passing urine." 5. "Drink at least 8 glasses of liquid each day."

Answer: 3,4 Option 1: Exploring different sexual positions will accommodate the changes of pregnancy. Option 2: Practicing Kegel exercises while urinating will help to strengthen the pelvic floor muscle. Option 3: Urinating immediately before and after sexual intercourse will decrease the risk for a UTI. Option 4: Wiping from back to front after passing urine will increase the risk of having a UTI. Option 5: Drinking at least 8 glasses of liquid each day will decrease the risk for a UTI.

The nurse has decided to implement the Centering Pregnancy model for prenatal care instead of the conventional antenatal care. which is the focus of this model of care? Select all that apply. 1. The nurse spends more time dealing with the complications of pregnancy. 2. The nurse will be better able to take responsibility for the clients' health. 3. The clients will be spending more time with the nurse in antenatal care. 4. More social support will be available for clients. 5. The clients will get one-on-one prenatal care

Answer: 3,4 Option 1: The focus will be on normalcy of pregnancy. Option 2: The focus is to promote individual responsibility for health in pregnancy. Option 3: The focus is to increase the time the clients spend in antenatal care. Option 4: The focus is to provide more social support for clients in antenatal care. Option 5: The focus is on having a small group of women to meet with the nurse.

During preconception counseling, the nurse is teaching a client about diagnosing pregnancy. Which signs are considered probable signs of pregnancy? Select all that apply. 1. Fetal heart tones 2. Quickening 3. Uterine growth 4. Frequent urination 5. Positive home pregnancy test

Answer: 3,5 Option 1: This is an objective sign of pregnancy that is only caused by the presence of a fetus, which makes it a positive sign of pregnancy. Option 2: Quickening is fetal movement felt by the mother. This is subjective and could be caused by something other than pregnancy, such as intestinal gas. Option 3: This is an objective measure that could be caused by something other than pregnancy, such as uterine fibroids or tumors, which makes it a probable sign of pregnancy. Option 4: Frequent urination can be caused by multiple factors other than pregnancy, such as bladder infection, increased water intake, diabetes, etc. It is a presumptive sign of pregnancy. Option 5: This is an objective measure that could produce false-positive or false-negative results, therefore making it a probable sign of pregnancy.

The nurse is documenting the obstetrical history of a client using the GTPAL system. The client is currently pregnant with her third child. Her first pregnancy resulted in the birth of a daughter at 38 weeks and 1-day gestation. Her second pregnancy resulted in the birth of a son at 35 weeks and 5 days gestation. Both are still living. What does the nurse document as the GTPAL?

Answer: 3-1-1-0-2 Correct Feedback Each pregnancy counts as a gravidity (two previous children + current pregnancy). The daughter born at 38 + 1 was term (T) and the son born at 35 + 5 was preterm (P). She had no abortions/miscarriages (A), and both her children are still living (L). Test Taking Tip: With GTPAL questions, it is helpful to write tally marks as you work through the question. If the patient is currently pregnant, remember to add that pregnancy in the gravidity column.

The nurse is conducting a presentation on the prevention of food-borne illnesses with the clients of the prenatal clinic. Which advice would the nurse emphasize? 1. Warm cooked food should be taken out of the refrigerator for more than two hours before consuming. 2. Drink plenty herbal teas such as peppermint and chamomile. 3. Refrigerate smoked seafood before consuming. 4. Wash hands before and after handling food.

Answer: 4 Option 1: Cooked food taken out of the refrigerator for more than two hours should be discarded. Option 2: Teas, such as peppermint and chamomile, can cause food-borne illnesses and should be avoided during pregnancy. Option 3: Refrigerated smoked seafood should be avoided in pregnancy. Option 4: Washing hands before and after handling food prevents the transmission of food-borne illness.

During the nursing assessment, a pregnant client reports that her spouse has been verbally abusive and slapped her recently. which is the priority nursing intervention at this time? 1. Document the statement in the woman's chart. 2. Call the police to report the incident. 3. Bring in another staff member as a witness to the statement. 4. Reassure her that she is not alone and help is available.

Answer: 4 Option 1: Documentation of the client's statement is important but is not the priority. Option 2: States may have mandatory reporting laws. However, the phone call can be made later and is not the priority. Option 3: Confidentiality is important when screening for intimate partner violence. The woman may feel a violation of privacy if other people are in the room. Option 4: Reassuring the client that she is not alone and that they are is believed is the nurse's first action.

A woman diagnosed with Gestational Diabetes Mellitus (GDM) was referred to have a Group B Streptococcus (GBS) screening done. At which stage of the pregnancy would the nurse recommend the client to have this screening done? 1. 10 to 12 weeks of gestation 2. 15 to 23 weeks of gestation 3. 24 to 28 weeks of gestation 4. 35 to 37 weeks of gestation

Answer: 4 Option 1: Doppler ultrasound is recommended between 10 to 12 weeks of gestation to assess the fetal heart tones. Option 2: Screening for neural tube defect and Trisomy 21 screening are recommended between 15 to 23 weeks of gestation. Option 3: Screening for Gestational Diabetes Mellitus is recommended between 24 to 28 weeks of gestation. Option 4: Screening for Group B Streptococcus is recommended between 35 to 37 weeks of gestation.

The nurse is discussing the physiological changes of pregnancy with a group of adolescent mothers. One clients ask the nurse if her skin will be affected also. Which statement by the nurse is correct about the changes that will take place in the integumentary system? 1. "You will have some skin changes such as gingivitis, bleeding gums, and periodontal disease." 2. "You will have some skin changes such as the Goodell's, Hegar's, and Chadwick signs." 3. "You will have some skin changes, such as edema of the limbs, varicosities, and hemorrhoids." 4. "You will have some skin changes, such as linea nigra, melasma, and striae gravidarum."

Answer: 4 Option 1: Gingivitis, bleeding gums, and periodontal disease are changes that take place in the gastrointestinal system. Option 2: Goodell's, Hegar's, and Chadwick signs are changes that take place in the reproductive system. Option 3: Edema of the limbs, varicosities, and hemorrhoids are changes that take place in the cardiovascular system. Option 4: Linea nigra, melasma, and striae gravidarum are changes that take place in the integumentary system.

The nurse is providing education regarding exercise and pregnancy. Which response by the client indicates an understanding of the teaching? 1. "I should start a new exercise routine to keep in shape." 2. "I will perform non-weight-bearing exercises." 3. "Exercise will help me lose weight during the pregnancy." 4. "Walking and stretching exercises will help with overall body conditioning."

Answer: 4 Option 1: Women should confer with their health care provider before starting any new exercise routine. It is best to start such a program several months in advance, so exercise is already comfortable and routine. Option 2: Weight-bearing exercises are recommended to enhance muscle tone and bone health. Option 3: Weight loss should not be a goal during pregnancy. Preconception weight loss is advisable if BMI is over normal. Option 4: Aerobic exercise and stretching helps condition the entire body, helps with weight management, and can enhance psychological well-being.

A client's first day of last menstrual period (LMP) was April 6, 2018. Using the Naegele's rule, what estimated date of delivery (EDD) will the nurse communicate to the client?

Answer: January 13, 2019 Test Taking Tip: To complete this problem, you need to know Naegele's formula and how to adjust the year as necessary.