maternity review chapter 14

Which of the following drugs and drug categories can cause multiple fetal central nervous system (CNS), facial, and cardiovascular anomalies?

. Isotretinoin (Accutane), the acne medication, can cause multiple central nervous system (CNS), facial, and cardiovascular anomalies.

A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest?

. The nurse should advise the client to practice dorsiflexion of feet to stretch affected muscle.

The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question?

. The nurse should remind the client of the need to check with her caregiver about medications. If a woman has taken a drug in category D or X, she should be informed of the risks associated with that drug and of her alternatives.

The nurse is presenting a prenatal class to a group of women pregnant for the first time who are all over 35 years of age. The nurse knows that the advantage of waiting until later to start a family is which of the following?

. This delay in starting a family allows women to pursue advanced educational degrees and prepare financially for the impact children will have on their lives.

The nurse is presenting a class of important "dos and don'ts" during pregnancy, including travel considerations. What method of travel does the nurse recommend as most appropriate for a client in her 25th week of pregnancy?

.As pregnancy progresses, travel by train is generally recommended for long distances.

During home care of a low-risk pregnant client, the nurse provides care by assessing which of the following?

1. Assessment of the client's urine can be done in the home setting. 2. Obtaining the client's weight can be done in the home setting. 3. Assessing the client's dietary intake can be done in the home setting. 5. The client's physical activity can be assessed in the home setting.

The prenatal period should be used to expose the prospective parents to up-to-date, evidence-based information about which of the following topics?

1. Breastfeeding 2. Pain relief 3. Obstetric complications and procedures

A couple in their late 30s are pregnant for the first time. In evaluating the care delivered, the nurse assesses the mother for which of the following?

1. Expected outcomes of nursing care for a pregnant couple over 35 include that the client and her partner are knowledgeable about the pregnancy and make appropriate healthcare choices. 2. Expected outcomes of nursing care for a pregnant couple over 35 include the client and her partner receive effective health care throughout the pregnancy, birth, and postpartum period.

The OB-GYN nurse works in a clinic with a culturally diverse group of clients whose specific actions during pregnancy are often determined by cultural beliefs. The nurse recognizes that these beliefs about pregnancy and childbirth fall into which categories?

1. Prescriptive beliefs or requirements describe expected behaviors. 2. Restrictive beliefs are stated negatively and limit behaviors. 3. Taboo beliefs refer to specific supernatural consequences.

A client at 34 weeks' gestation complains about pyrosis. The nurse teaches the patient that approaches to relieve the pyrosis include which of the following?

1. Pyrosis (heartburn) can be relieved by eating small, more frequent meals. 3. Avoiding fatty, fried foods can relieve pyrosis. 5. Sitting up after meals will help decrease the pyrosis.

Which of the following are specific culturally sensitive nursing considerations the nurse integrates into care of the pregnant client?

1. The culturally sensitive nurse should find out what medications and home remedies the client is using, and counsel the client regarding overall effects. 2. The culturally sensitive nurse will discuss the importance of a well-balanced diet during pregnancy with consideration of the client's cultural beliefs and practices. 4. Encouraging the use of support systems and spiritual aids that provide comfort for the mother is important in culturally sensitive care.

The nurse is presenting a class to women who are currently pregnant or are planning pregnancy in the near future. Which client statement indicates that additional teaching is required?

1. The health risks associated with pregnancy vary by age. The risk for maternal death is significantly higher for women over age 35 and even higher for women age 40 and older. The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older.

What self-care measures would a nurse recommend for a client in her first trimester to reduce the discomfort of nausea and vomiting?

1. The nurse would recommend for a client in her first trimester to avoid odors and caustic factors to reduce the discomfort of nausea and vomiting. 2. The nurse would recommend for a client in her first trimester to have small but frequent meals to reduce the discomfort of nausea and vomiting. 3. The nurse would recommend for a client in her first trimester to drink carbonated beverages to reduce the discomfort of nausea and vomiting.

Remedies for back pain in pregnancy that are supported by research evidence and may safely be taught to any pregnant woman by the nurse include which of the following?

1. The pelvic tilt can help restore proper body alignment and relieve back pain. 2. Exercise is an effective treatment for lower back pain. Exercise in water seems to provide benefits while being physically comfortable for expectant mothers. 4. The use of proper posture and good body mechanics throughout pregnancy is important. 5. Good posture is important because it allows more room for the stomach to function.

Absolute contraindications to exercise while pregnant include which of the following?

2. Placenta previa after 26 weeks' gestation is an absolute contraindication to exercise. 3. Preeclampsia-eclampsia is an absolute contraindication to exercise. 4. Cervical insufficiency (cerclage) is an absolute contraindication to exercise.

The nurse is preparing a brochure for couples considering pregnancy after the age of 35. Which statements should be included?

2. Preexisting medical conditions, such as hypertension or diabetes, probably play a more significant role than age in maternal well-being and the outcome of pregnancy. 3. The incidence of low-birth-weight infants, preterm births, miscarriage, stillbirth, and perinatal morbidity and mortality is higher among women age 35 or older. 4. Amniocentesis is offered to all women over age 35 to permit the early detection of several chromosomal abnormalities, including Down syndrome; noninvasive analysis of fetal nucleic acid is now commonly recommended to women of advanced maternal age.

A pregnant client complains to the clinic nurse that her varicose veins are causing more discomfort than before. Which recommendations does the nurse make to the client?

2. Regular exercise, such as swimming, cycling, or walking, promotes venous return, which helps prevent varicosities. 3. The client should avoid crossing her legs at the knees because of the pressure it puts on her veins. 4. Supportive hose or elastic stockings may be extremely helpful.

The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is the best for the nurse to use to assess the father's adaptation to the pregnancy?

A husband's adaptation to pregnancy includes his feelings about impending fatherhood.

A Chinese woman who is 12 weeks pregnant reports to the nurse that ginseng and bamboo leaves help reduce her anxiety. How should the nurse respond to this client?

Advise the client to give up all herbal remedies; In some cases, the nurse might want to suggest remedies that may be more effective than herbal remedies. However, if the home remedy is not harmful, there is no reason for the nurse to ask a client to discontinue this practice.

The nurse assessing a pregnant African American woman in the first trimester understands that a cultural practice is which of the following?

African American pregnant women may be guided by their extended family into common practices such as geophagia, the ingestion of dirt or clay, which is believed to alleviate mineral deficiencies.

The nurse is discussing sexual intimacy with a pregnant couple. What should be included in the teaching plan?

As the uterus enlarges, the couple will have to experiment with different positions.

A 43-year-old client has just had a positive pregnancy test. She cries, and states, "I just don't know what I'll do. I can't be pregnant." Which nursing diagnosis would be the most appropriate?

Decisional Conflict related to unexpected pregnancy is the most appropriate nursing diagnosis.

Which statement, if made by a pregnant client, would indicate that she understands health promotion during pregnancy?

Elevating the legs can help decrease lower leg edema.

A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. What is the most appropriate nursing response?

Even mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred.

A client at 36 weeks' gestation is complaining of dyspnea when lying flat. What is the clinical reason for this complaint?

Fundal height; The dyspnea is resulting from the pressure of the enlarging uterus on the diaphragm.

The nurse is preparing a class for expectant fathers. Which information should the nurse include?

In a healthy pregnancy, there is no medical reason to limit sexual activity.

The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement by a client requires immediate intervention by the nurse?

Increased whitish vaginal discharge, called leukorrhea, is common in pregnancy. Green discharge is not a normal finding, and indicates a vaginal infection.

Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis?

Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor.

The nurse working with mothers over 35 having their first baby knows there are some disadvantages. For what disadvantage would the nurse carefully assess in each client?

It is important for the nurse to question and assess for any chronic illnesses. The risk of pregnancy complications is higher in women over age 35 who have a chronic condition such as hypertension or diabetes, or who are in poor general health.

The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make?

Many pregnant women will develop hemorrhoids. Hemorrhoids are varicosities of the veins in the lower end of the rectum and anus. During pregnancy, the gravid uterus presses on the veins and interferes with venous circulation. As the pregnancy progresses, the straining that accompanies constipation can contribute to the development of hemorrhoids.

A pregnant client who swims 3-5 times per week asks the nurse whether she should stop this activity. What is the appropriate nursing response?

Mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred.

The nurse in a prenatal clinic finds that four clients have called with complaints related to their pregnancies. Which call should the nurse return first?

Pregnant woman at 15 weeks' gestation with nausea and vomiting and a 15-pound weight loss;The nurse should return this call first because this patient is the highest priority. A 15-pound weight loss is not an expected finding. Although some nausea is common, the woman who suffers from extreme nausea coupled with vomiting requires further assessment.

The prenatal client in her third trimester tells the clinic nurse that she works 8 hours a day as a cashier and stands when at work. What response by the nurse is best?

Pregnant women who are employed in jobs that require prolonged standing (more than 3 hours) do have a higher incidence of preterm birth.

After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement?

Smoking is not associated with increased risk for preeclampsia.

A Navajo client who is 36 weeks pregnant meets with a traditional healer as well as her physician. What does the nurse understand this to mean?

The client is seeking spiritual direction.

The pregnant client in her second trimester states, "I didn't know my breasts would become so large. How do I find a good bra?" The best answer for the nurse to make would be which of the following?

The nurse should instruct the client to get a bra that fits with straps that are wide and do not stretch and a cup that holds all breast tissue comfortably.