MATERNITY Saunders Jan 27th

A perinatal client is at risk for toxoplasmosis. Which instruction would the nurse reinforce with the client to prevent exposure to this disease?

Avoid exposure to litter boxes used by cats. Rationale: Infected house cats transmit toxoplasmosis through feces. Handling litter boxes can transmit the disease to the maternity client. Meats that are undercooked can harbor microorganisms that can cause infection. Hands should be washed throughout the day when items that could be contaminated are handled. Topical corticosteroid treatment is not the pharmacological treatment of choice for toxoplasmosis.

A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the mother that fetal movements should be noted at which time interval?

Between 16 and 20 weeks' gestation Rationale: Fetal movement, called quickening, is not perceived until the second trimester. Between 16 and 20 weeks of gestation the expectant mother first notices subtle fetal movements that gradually increase in intensity.

A pregnant client is seen in the health care clinic with reports of morning sickness. When the client asks the nurse about measures to relieve this situation, what is the nurse's appropriate suggestion?

Consume dry crackers before getting out of bed. Rationale: Some strategies for decreasing morning sickness are keeping crackers, melba toast, or dry cereal at the bedside to eat before getting up in the morning; eating smaller, more frequent meals; decreasing fats; and consuming adequate fluid between meals.

The nurse is teaching a pregnant client about the physiological effects and hormone changes that occur in pregnancy. The client asks the nurse about the purpose of estrogen. Which description explains the purpose of estrogen?

Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Rationale: Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat and is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

The nurse is reinforcing instructions to a pregnant client about the warning signs in pregnancy that require the need to notify the primary health care provider. The nurse determines that further teaching is needed if the client states that it is necessary to call the primary health care provider if which occurs?

Irregular, painless contractions Rationale: Clients should be educated regarding the danger signs of pregnancy. Generalized or facial edema, rapid weight gain and visual disturbances are warning signs in pregnancy. Braxton Hicks contractions are the normal, irregular, painless contractions of the uterus that may occur throughout the pregnancy. Additional warning signs in pregnancy include vaginal bleeding, premature rupture of the membranes, preterm uterine contractions that are normal and regular, change in or absence of fetal activity, severe headache, epigastric pain, persistent vomiting, abdominal pain, and signs of infection.

A pregnant client asks the nurse about the hormone that stimulates postpartum contractions. The nurse tells the client that which primary hormone stimulates postpartum contractions?

Oxytocin Rationale: Oxytocin stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Prolactin stimulates the secretion of milk, called lactogenesis. Progesterone stimulates the secretions of the endometrial glands and causes the endometrial vessels to become dilated and tortuous in preparation for possible embryo implantation. Testosterone is produced by the adrenal glands in the female and induces the growth of pubic and axillary hair at puberty.

The nurse is checking a client's record for probable signs of pregnancy. Which are the probable signs of pregnancy that the nurse would note? Select all that apply.

Ballottement,Chadwick's sign,Uterine enlargement,Braxton Hicks contractions Rationale: The probable signs of pregnancy include uterine enlargement; Hegar's sign (the compressibility and softening of the lower uterine segment that occurs at about week 6); Goodell's sign (the softening of the cervix that occurs at the beginning of the second month of pregnancy); Chadwick's sign (the violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4); ballottement (the rebounding of the fetus against the examiner's fingers on palpation); Braxton Hicks contractions; and a positive pregnancy test that measures for human chorionic gonadotropin. Positive signs of pregnancy include a fetal heart rate that is detected by an electronic device (Doppler transducer) at 10 to 12 weeks' gestation and by a nonelectronic device (fetoscope) at 20 weeks' gestation; active fetal movements that are palpable by the examiner; and an outline of the fetus via radiography or ultrasound.

A woman diagnosed previously with gestational hypertension is returning to the clinic for her scheduled prenatal appointment. During the assessment, the nurse is concerned that she is developing signs/symptoms that indicate that her mild gestational hypertension is progressing. What assessment findings indicate to the nurse that the mild gestational hypertension is progressing? Select all that apply.

Blood pressure (BP) 165/120 mm Hg Complaints of headache for the last 12 hours Rationale: Severe gestational hypertension or preeclampsia may be forms of progression of mild gestational hypertension. In a worsening case, the blood pressure (BP) increases above 140/90 as does the proteinuria. The woman begins to have complaints of neurological symptoms. Elevated blood pressure and headaches are correct.

The nurse is collecting data from the client about the presence of presumptive, probable, and positive signs of pregnancy. Which are the positive signs of pregnancy? Select all that apply.

Fetal heart tones, Fetal movements felt by examiner

The nurse is collecting data from a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks, and she tells the nurse that she does not have a history of any type of abortion or fetal demise. The nurse would document which as the GTPAL for this client?

G = 2, T = 1, P = 0, A = 0, L = 1 Rationale: Pregnancy outcomes can be described with the GTPAL acronym: G = gravidity (number of pregnancies); T = term births (number born after 37 weeks); P = preterm births (number born before 37 weeks' gestation); A = abortions/miscarriages (number of abortions/miscarriages); L = live births (number of live births or living children). Therefore, a woman who is pregnant with twins and who already has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of preterm births is 0, and the number of term births is 1. The number of abortions is 0, and the number of live births is 1.

The nurse reviews the antenatal history of a client in early labor. The nurse recognizes that which factor noted in the history presents the greatest potential for causing neonatal sepsis following delivery?

History of substance abuse during this pregnancy Rationale: Risk factors for neonatal sepsis can arise from maternal, intrapartal, or neonatal conditions. Maternal risk factors before delivery include low socioeconomic status, poor prenatal care and nutrition, and a history of substance abuse during pregnancy. Weight gain of 25 to 35 pounds is acceptable for a woman of average nonpregnant weight. Prenatal care beginning in the first trimester is not an added risk factor. Premature rupture of the membranes or prolonged rupture of membranes greater than 18 hours before birth is also a risk factor for neonatal acquisition of infection.

The nurse is teaching a prenatal class on the anatomy and physiology of the female reproductive system including hormones. Estrogen produces which effects, either directly or indirectly, during pregnancy? Select all that apply.

Increases blood flow to the uterine vessels Stimulates development of the breast ducts Causes vascular changes in the mucous membranes of the nose and mouth Rationale: Estrogen increases the blood flow to the uterine blood vessels. It stimulates the development of the breast ducts in preparation for lactation. It also increases vascular changes in the skin and the mucous membranes of the nose and mouth. It also increases, rather than decreases, salivation. Estrogen also increases skin pigmentation, which accounts for the "mask of pregnancy."

The nurse is caring for a pregnant client with a history of human immunodeficiency virus (HIV). Which problem has the highest priority for this client?

Potential for infection Rationale: Clients with HIV often show some evidence of immune dysfunction and may have increased vulnerability to infection. Although the client may have difficulty tolerating activity and need assistance with hygiene measures, these are not the priority concerns. Although imbalanced nutrition is a concern, infection is specifically related to HIV and is a priority.

The nurse is monitoring a pregnant client with gestational hypertension (GH) who is at risk for preeclampsia. The nurse would check the client for which signs of preeclampsia?

Proteinuria ,Hypertension Rationale: Signs of preeclampsia are hypertension and proteinuria. A low-grade fever, increased pulse rate, and increased respiratory rate are not associated with preeclampsia.

During an initial prenatal visit, the nurse notes that the primary health care provider documents that the client is experiencing iron deficiency anemia. Which client data support this finding?

Reports of fatigue, Pink mucous membranes Anemia is a common problem in pregnancy and is characterized by a hemoglobin level of less than between 10.5 and 11 g/dL. Iron deficiency anemia and folic acid deficiency are two common types of anemia that present a concern during pregnancy. Although fatigue may be seen in some pregnant women, its presence may reflect complications caused by decreased oxygen supply to vital organs, thus supporting the laboratory findings. The other options are normal observations during pregnancy.

The nurse is assisting in performing a prenatal examination on a client in the third trimester of pregnancy. The primary health care provider performs Leopold's maneuvers on the client. Which maneuver indicates the position of the fetus?

Second Rationale: The first maneuver is to determine the presentation and lie of the fetus. The second maneuver indicates the position of the fetus. The third maneuver can determine whether the fetus is engaged in the pelvis. The fourth maneuver indicates the attitude of the fetus. Leopold's maneuvers should not be performed during a contraction.

The nursing instructor asks the nursing student to identify the reason that the pulse rate of a client in the second trimester of pregnancy has increased since the last visit. Which response indicates that the student understands the rationale of this physiological response?

"Blood volume and cardiac output increase resulting in a faster pulse." etween 14 and 20 weeks of gestation, the pulse increases slowly, up 10 to 15 beats per minute, which lasts until term. Cardiac output and blood volume increase. Blood pressure decreases not increases during the first half of pregnancy, returning to baseline in the second half of pregnancy. Although excitement may cause an increase in pulse rate, the likely cause is the combination of normal physiological changes that occur during pregnancy. An increase in the pulse rate is not due to a cardiac malfunction. The remaining options are not supported by the information given in the question.

The nurse in the prenatal clinic is taking a nutritional history from a pregnant adolescent. Which statement by the client would alert the nurse to a potential concern regarding adequate nutritional intake during the pregnancy?

"I need to gain only 10 pounds so that my baby will be small like I am." Rationale: Pregnant adolescents are at higher risk for complications than are other pregnant clients. Adolescents are often concerned about their body image. If weight is a major focus, the adolescent is more likely to restrict calories to avoid weight gain. Only gaining 10 pounds, which is much too restrictive regarding weight gain, is the only response that suggests a possible concern. Option 1 expresses an attempt to consume required vegetables. Options 3 and 4 indicate that the client will consume items that will help increase calcium intake.

The nurse is reinforcing instructions to a pregnant client regarding dietary measures to promote a healthy pregnancy. The nurse instructs the client to consume an adequate intake of fluid on a daily basis. Which statement by the client indicates an understanding of the daily fluid requirement?

"I should drink 8 to 12 glasses of liquid in addition to my daily milk requirement." Rationale: The nurse should instruct the client to drink an adequate fluid intake on a daily basis to assist in digestion and in the management of constipation: 8 to 12 glasses of liquids (1500 to 2000 mL) in addition to the daily milk requirement are recommended every day. This fluid should be water or fruit and vegetable juices rather than carbonated soft drinks or caffeinated beverages.

A contraction stress test is scheduled for the client. The woman asks the nurse about the test. Which response describes the most accurate description of the test?

"The uterus is stimulated to contract by either small amounts of oxytocin or by nipple stimulation." Rationale: A contraction stress test assesses placental oxygenation and function and determines the fetus's ability to tolerate labor, as well as its well-being. The test is performed if the nonstress test result is abnormal. During the stress test, the fetus is exposed to the stressor of contractions to assess the adequacy of placental perfusion under simulated labor conditions. An external fetal monitor is applied to the mother, and a 20- to 30-minute baseline strip is recorded. The uterus is stimulated to contract, either by the administration of a dilute dose of oxytocin or by having the mother use nipple stimulation, until three palpable contractions with a duration of 40 seconds or more during a 10-minute period have occurred. Frequent maternal blood pressure readings are performed and the client is monitored closely while increasing doses of oxytocin are given. Leopold's maneuvers are performed to locate the position of the fetus. Only external fetal monitoring is employed.

A pregnant woman in her second trimester calls the prenatal clinic nurse to report a recent exposure to a child with rubella. Which response by the nurse is appropriate?

"You were wise to call. I will check your rubella titer screening results, and we can identify immediately if interventions are needed." Rationale: Mineral oil should not be used as a stool softener because it inhibits the absorption of fat-soluble vitamins in the body. Constipation should be treated with increased fluids (six to eight glasses per day) and a diet high in fiber. Increasing exercise is also an excellent way to improve gastric motility.

A pregnant client is anxious to know the gender of the fetus and asks the nurse when she will be able to know. The nurse responds by telling the client that the gender of the fetus can usually be determined by which range of weeks?

12 to 16 Rationale: By the end of the twelfth week, the fetal gender can be determined by the appearance of the external genitalia on ultrasound.

A nulliparous woman asks the nurse when she will feel fetal movements. The nurse responds by telling the woman that the first recognition of fetal movement will occur at approximately which week of gestation?

18 The first recognition of fetal movements, or "feeling life," by the multiparous woman may occur as early as the fourteenth to sixteenth week of gestation. The nulliparous woman may not notice these sensations until the 18th week of gestation or later. The first recognition of fetal movement is called quickening.

The perinatal client is admitted to the obstetrical unit during an exacerbation of a heart condition. When planning for the nutritional requirements of the client, the nurse would consult with the dietitian to ensure which dietary measure?

A diet that is high in fluids and fiber to decrease constipatioN Rationale: Constipation causes the client to use Valsalva's maneuver. This causes blood to rush to the heart and overload the cardiac system. The absence of weight gain is not recommended during pregnancy. Diets that are low in fluid and fiber cause a decrease in blood volume, which in turn deprives the fetus of nutrients. Too much sodium could cause an overload to the circulating blood volume and contribute to the cardiac condition.

The nurse is collecting data from a prenatal client. The nurse determines that which situation places the client in the high-risk category for contracting human immunodeficiency virus (HIV)?

A history of intravenous (IV) drug use in the past year Rationale: HIV is transmitted by intimate sexual contact and by the exchange of body fluids, exposure to infected blood, and the transmission from an infected woman to her fetus. Women who fall into the high-risk category for HIV infection include those with persistent and recurrent sexually transmitted infections or a history of multiple sexual partners and those who use or have used IV drugs. The remaining options are not situations that contribute to contracting HIV infection.

While assisting with the measurement of fundal height, the client at 36 weeks' gestation states that she is feeling lightheaded. On the basis of the nurse's knowledge of pregnancy, the nurse determines that this is most likely a result of which reason?

Compression of the vena cava Rationale: Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome during pregnancy. Having the woman turn onto her left side or elevating the right buttock during fundal height measurement will prevent or correct the problem. Options 1, 2, and 3 are not the cause of the problem described in the question.

A nurse is monitoring a pregnant client for the warning signs/symptoms of gestational hypertension. Which are signs/symptoms of this complication of pregnancy?

Edema,Proteinuria,Thrombocytopenia

The client arrives at the prenatal clinic for her first prenatal assessment. The client tells the nurse that the first day of her last menstrual period (LMP) was October 20, 2022. Using Nägele's rule, the nurse determines the estimated date of birth is which date?

July 27 2023

The nurse is told that a prenatal client is at risk for placental abruption. The nurse expects to note which risk factor documented in the client's record?

Maternal hypertension Rationale: Maternal hypertension is a risk factor associated with placental abruption. This factor leads to degenerative changes in the small arteries that supply the intervillous spaces of the placenta. This results in thrombosis, causing retroplacental hematoma and leading to placental separation. Oliguria, gestational diabetes, and hyperemesis gravidarum are not associated risk factors.

The nurse encourages the childbearing woman diagnosed with human immunodeficiency virus (HIV) to avoid alcohol and cigarettes during pregnancy and to obtain adequate rest. Which outcome is specific to this client?

Minimize the potential for developing infections. Rationale: The pregnant client with HIV needs to avoid practices that can compromise the maternal immune system and interfere with medical treatments that may be in place. Collectively, such practices may place both the mother and fetus at additional risk during the pregnancy. The remaining options are not as specific to the care of this client.

The nurse assigned to care for a client with mild preeclampsia would anticipate which specific nursing intervention for this client?

Monitoring fetal movement Rationale: A client with mild preeclampsia can be managed at home. The expectant mother is asked to keep a record of fetal movements. Bed rest with bathroom privileges is prescribed. Urine is checked for protein. A blood glucose test is not necessary. The client usually follows a regular diet that does not restrict fluids.

Types of Pelvis: Gynecoid

Normal and most favorable for delivery

A pregnant woman reports that she has just finished taking the prescribed antibiotics to treat a urinary tract infection. The mother expresses concern that her baby will be born with an infection. Which response would the nurse make to help reduce the maternal fears that the newborn will be born with an infection?

Now that you have taken the medication as prescribed, we will continue to monitor you closely by repeating the urine culture before you leave today." Rationale: Symptomatic bacteriuria has been associated with an increased risk of neonatal sepsis following delivery. Appropriate antenatal care of a client with a urinary tract infection includes antibiotic treatment and follow-up repeat urine cultures. Option 4 is the only response that is both therapeutic and identifies accurate information.

The nurse is reinforcing instructions to a client about preterm labor. Which method of teaching would the nurse use?

Palpate for uterine contractions at the same time as the client. Rationale: Palpating simultaneously with the client uses teaching and learning principles. It includes the most direct way to determine the level of client understanding. The client may not be able to read well. The client may not understand what to feel for with contractions and may answer only to please the nurse. A monitor would be cost prohibitive and does not give human feedback.

The nurse is reinforcing instructions to a pregnant client regarding measures that will strengthen the perineal floor muscles. Which would the nurse include in the instructions?

Perform Kegel exercises in 10 repetitions, three times per day. Rationale: Kegel exercises strengthen the pelvic floor. Option 1 relates to hydration that is important for normal physiological body functioning. Option 2 will help prevent urinary tract infections. Pelvic tilt exercises will reduce backache.

A pregnant client is a gravida III, para 0, abortus II. She is placed on bed rest at home because of preterm labor. The nurse provides information to the husband, knowing that which instruction will assist in promoting family adaptation?

Teaching the husband to perform passive range of motion and provide back rubs for his wife Rationale: Range-of-motion exercises will help maintain muscle tone during bed rest, and back rubs provide skin-to-skin contact and are comforting. The inclusion of the significant other promotes adaptation and decreases the sense of isolation. Telling the husband that sexual intercourse has led to the preterm labor will lead to guilt and maladaptation. The husband should not be expected to titratemedications. Kegel exercises are beneficial but will not provide the human-to-human contact that promotes family adaptation.

The nurse is preparing a 36-year-old gravida II, para I pregnant client for an amniocentesis. She is at 16 weeks of gestation. Which action would the nurse take before the procedure to ensure fetal safety?

Test the ultrasound equipment to ensure proper functioning. Rationale: Before 20 weeks of gestation, it is recommended to perform an amniocentesis with the bladder full. This pushes the uterus upward for better visualization. After week 20, the bladder is emptied before the test to minimize the risk of puncturing it during the test. Teaching the client about signs and symptoms of labor before the procedure does not ensure fetal safety. The local anesthetic makes the insertion of the needle less painful but does not protect the fetus. The use of ultrasound to guide the procedure has greatly decreased the risk of fetal and placental damage during the procedure.

The nurse is monitoring a client with mild gestational hypertension (GH). Which data indicate that GH is a concern?

The client complains of a headache and blurred vision. Rationale: Options 1, 2, and 4 are all signs that gestational hypertension is not present. Option 3 is a symptom of the worsening of the gestational hypertension and is a concern that needs to be reported.

Naegele's Rule

add 7 days to LMP, subtract 3 months, add 1 year

Gravida/Para

Gravida (gravidity): # of Pregnancies Para (parady): # of live births WOMAN HAS TWO KIDS, ONE ABORTION, AND IS CURRENTLY PREGNANT: Gravida = 4; Para = 2

The client at 28 weeks' gestation is Rh negative and Coombs antibody negative. The nurse determines that the client understands what the nurse has taught her about Rh sensitization when the client makes which statement?

"I will tell the nurse at the hospital that I had an Rh shot during pregnancy." Rationale: As described in the question, it is accepted practice to administer Rho(D) immune globulin to an Rh-negative woman at 28 weeks' gestation, with a second injection within 72 hours of delivery. This prevents sensitization, which could jeopardize a future pregnancy. For subsequent pregnancies or abortions, the injections must be repeated, because the immunity is passive. Options 1, 2, and 3 are inaccurate information.

A pregnant client in the second trimester of pregnancy is admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which finding would the nurse expect to note if this condition is present?

Abdominal pain Rationale: Classic signs and symptoms of abruptio placentae include vaginal bleeding, abdominal pain, uterine tenderness, and contractions. Mild to severe uterine hypertonicity is present. Pain is mild to severe and either is localized over one region of the uterus or is diffuse over the uterus, with a boardlike abdomen. Painless vaginal bleeding and a soft, nontender uterus in the second or third trimester of pregnancy are signs of placenta previa.

A client in her 24th week of pregnancy is admitted to the hospital in preterm labor. She asks the nurse if her baby will live if the labor cannot be stopped. Which diagnostic test would the nurse expect the primary health care provider to prescribe?

Amniocentesis for fetal surfactant level An amniocentesis is performed to obtain a specimen of fluid to detect the surfactant level.

A nursing instructor instructs the nursing students that surfactant is a substance needed to facilitate neonatal breathing. Which statements made by the nursing students indicate understanding regarding the presence of surfactant?

Surfactant, which is needed for lung expansion, is present beginning at 28 weeks." "With decreased surfactant, more pressure must be generated to produce inspiration." "Surfactant lowers surface tension, reducing the pressure required to keep the alveoli expanded." Rationale: The alveoli of the term infant's lungs are lined with surfactant. Surfactant, a substance needed to facilitate neonatal breathing, begins to be produced at approximately week 28. When surfactant is decreased or absent, more pressure will be needed to produce and maintain inspiration. Surfactant is responsible for lowering surface tension, which allows the alveoli to more easily remain open. Surfactant is produced by type 2 lung cells and is not a part of the clotting mechanism for the newborn.

The nurse is preparing a pregnant client for a transvaginal ultrasound exam. The nurse should tell the client that which will occur?

The client will feel some pressure when the vaginal probe is moved. Rationale: Transvaginal ultrasonography, in which a lubricated probe is inserted into the vagina, allows evaluation of the pelvic anatomy. A transvaginal ultrasound exam is well tolerated by most clients because it alleviates the need for a full bladder. The client is placed in a lithotomy position or with her pelvis elevated by towels, cushions, or a folded blanket. The procedure is not physically painful, although the woman may feel pressure as the probe is moved.

The nurse is reviewing the record of a pregnant client and notes that the primary health care provider has documented the presence of Chadwick's sign. Which clinical finding supports the documentation of Chadwick's sign?

Violet bluish color of vaginal mucosa and cervix Rationale: The cervix undergoes significant changes following conception. The most obvious changes occur in color and consistency. In response to the increasing levels of estrogen, the cervix becomes congested with blood, resulting in the characteristic bluish tinge that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. Softening of the cervical tip is Goodell's sign. Softening of the uterine isthmus is Hegar's sign. Rebounding of the fetus is known as ballottement.

During the first trimester of pregnancy, a client complains of frequent nausea followed by vomiting. On data collection, which finding indicates a serious nutritional disorder of pregnancy?

Weight compared to last visit is a loss of 2.3 pounds Weight loss along with the signs/symptoms described in the question could indicate hyperemesis gravidarum

A nonstress test is prescribed for a pregnant client, and the client asks the nurse about the procedure. Which informative statement would the nurse provide to the client?

An ultrasound transducer that records fetal heart activity is secured over the abdomen where the fetal heart is heard most clearly." Rationale: A nonstress test is a noninvasive test, and an ultrasound transducer that records fetal heart activity is secured over the maternal abdomen where the fetal heart is heard most clearly. A tocodynamometer that detects uterine activity and fetal movement is then secured to the maternal abdomen. Fetal heart activity and movements are recorded. The test is termed "nonstress" because it consists of monitoring only; the fetus is not challenged or stressed by uterine contractions to obtain the necessary data. The nonstress test takes about 30 to 40 minutes.

A pregnant client has just been admitted to the hospital with severe preeclampsia. The nurse knows it is important to monitor for additional complications at this time. Which assessment would be part of the plan of care?

Any bleeding, such as in the gums, petechiae, and purpura Rationale: Bleeding is an early sign of disseminated intravascular coagulation (DIC), a complication of preeclampsia, and should be reported. Breast enlargement, feeling hot, and having alternate periods of fetal rest and activity are normal occurrences in the last trimester of pregnancy.

The nurse is collecting data from a client who is pregnant with twins. The nurse understands that which complications are more likely to occur with a twin pregnancy?

Preterm labor, Maternal anemia Rationale: There is a higher incidence of preterm labor occurring in multiple gestations. In addition, maternal anemia occurs in a client pregnant with twins because the maternal system is nurturing more than one fetus. Preterm labor, rather than postterm labor is likely to occur. Hydramnios not oligohydramnios may be associated with a twin pregnancy as a result of increased renal perfusion from cross-vessel anastomosis with monozygotic twins. Gestational diabetes is not a complication of a twin pregnancy.

The nurse is assisting in conducting a prenatal session with a group of expectant parents. Which comment related to female hormones made by a parent indicates the need for further teaching?

Prolactin is the hormone responsible for the initiation of labor." Rationale: Prolactin stimulates the secretion of milk, called lactogenesis. Oxytocin stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Progesterone stimulates the secretions of the endometrial glands, causing endometrial vessels to become highly dilated and tortuous in preparation for possible embryo implantation.

The nurse is collecting data from a pregnant client when the client asks the nurse about the purpose of the fallopian tubes. Which is the accurate response the nurse would make?

Where fertilization occurs Rationale: Each fallopian tube is a hollow muscular tube that transports a mature oocyte for final maturation and fertilization. Fertilization typically occurs near the boundary between the ampulla and the isthmus of the tube. The vagina is the organ of copulation, and the fetus develops in the uterus. Estrogen is a hormone that is produced by the ovarian follicles, the corpus luteum, the adrenal cortex, and the placenta during pregnancy. Progesterone is a hormone that is secreted by the corpus luteum of the ovary, the adrenal glands, and the placenta during pregnancy.