Prenatal Care and Teaching

Which statement by a pregnant woman after attending a prenatal education session indicates the need for additional teaching?

"During pregnancy it's safe for me to use my regular herbal remedies."

Which instruction would the nurse give to the pregnant client with anemia?

Drink orange juice with an iron supplement.

After a client has a spontaneous abortion at 12 weeks' gestation, the nurse notes that both she and her partner are visibly upset and crying. Which statement would be a therapeutic response?

"I'll be here if you want to talk."

Which general body system undergoes the most profound change during pregnancy?

Cardiovascular system

For which reason is an ultrasound done during the first trimester?

Estimate fetal age

Which is a neonatal effect of maternal smoking during pregnancy?

Low birth weight

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy?

Progesterone

Which is an appropriate response to a client who is 8 weeks pregnant and is concerned because she doesn't "feel like making love to her husband since becoming pregnant" and she doesn't "think he understands"?

"A decrease in libido is common during the first trimester of pregnancy." Often the pregnant woman experiences a decrease in sexual desire during the first trimester, probably as a result of nausea and vomiting; if couples are informed about this, they are less likely to become distressed. The client has already stated that the problem began with pregnancy. The client is asking the nurse for information; the client may be unable to tell the nurse. Stating that the client's husband will understand that this feeling is related to the client's pregnancy does not tell the client why this feeling is occurring; furthermore, it offers false reassurance.

Which suggestion would the nurse make to a client with morning sickness?

"Eat dry crackers before you get out of bed."

A couple in their late 30s are in the first trimester of pregnancy and have been referred to genetic counseling because of a family history of an inheritable problem and advanced maternal age. They are concerned because they believe that genetic counseling will favor abortion if studies reveal a defective fetus. Which response would the nurse provide regarding genetic counseling?

"Families are helped to understand the diagnosis, the probable cause of the disorder, and how the condition can be managed."

Which client statement indicates understanding of prenatal instructions in the third trimester regarding when to consult with a health care provider?

"I'll call the clinic if I have abdominal pain." Abdominal pain should be reported immediately, because it may indicate abruptio placentae or the epigastric discomfort of severe preeclampsia. Mild, irregular contractions are preparatory (Braxton-Hicks) contractions, which are common and are believed to help prepare the uterus for labor. Swelling of the ankles in the evening is physiologic edema of pregnancy, caused by pressure of the gravid uterus that impedes venous return; it disappears with elevation of the legs. Leukorrhea occurs during pregnancy as a result of increases in the estrogen and progesterone levels, which cause the vaginal discharge to become more alkaline.

Which statement indicates that a pregnant client requires further teaching about fetal growth and development?

"The fetus gets nutrients from the amniotic fluid."

Which is correct regarding the safety of caffeinated beverages during pregnancy?

- One 12-ounce cup of coffee per day is probably fine. - High consumption is often related to a decrease in birth weight.

The pregnant client is 5 ft 3 in (160 cm) tall and weighs 130 lb (57 kg) at the beginning of her pregnancy. Which weight would be recommended for her to reach at the end of the pregnancy?

155 lb (68 kg) A weight of 155 lb (70 kg) would put the client within the recommended weight gain of 25-35 lb (11-15.9 kg) for a woman with a normal body mass index (BMI) before pregnancy. A weight of 140 lb (63.5 kg) is less than the recommended weight gain for a women of average weight for height before pregnancy, as is 135 lb (61 kg). A weight of 170 lb (77.1 kg) would mean that the client gained more than the recommended amount.

Which factor accounts for the greatest portion of weight gain during pregnancy?

Fetal growth

Which nursing action is most appropriate for a pregnant client at 23 weeks' gestation with pica?

Determining whether the diet is safe and nutritionally adequate.

While conducting prenatal teaching, the nurse explains to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. Which factor does the nurse identify as the cause of this increase?

Increased production of estrogen

Which date would be calculated as the expected date of birth (EDB) for a pregnant client who states her last menstrual period began on January 11 and that she also had light spotting on February 7?

October 18 Add 7 days to the date of the last menstrual period, then subtract 3 months.

How would the nurse explain physiological anemia to a pregnant client?

Plasma volume increases.

On a routine prenatal visit, which is the sign or symptom that a healthy primigravida at 20 weeks' gestation will most likely report for the first time?

Quickening The recognition of fetal movement commonly occurs in primigravidas at 18 to 20 weeks' gestation; it is felt about 2 weeks earlier in multigravidas. Palpitations should not occur in the healthy primigravidas. Pedal edema may occur at the end of the pregnancy as the gravid uterus presses on the femoral arteries, impeding circulation. Immediate follow-up care is required when it occurs this early in the pregnancy. Vaginal spotting at this time requires immediate follow-up care.

A woman arrives for an appointment at an obstetrics clinic. During the visit the nurse records the following information. Which finding indicates a need for future intervention?

Rubella titer less than 1:8 (nonimmune)

Which information would the nurse provide to the client who is to have a pelvic examination on her first visit to the prenatal clinic?

The uterus will be assessed for growth

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea throughout the day. Which interventions would the nurse recommend?

1. Focus on and repeat a rhythmic chant. 2. Eat small, frequent meals and eat dry crackers in between.

Which information regarding risks that may result from an untreated chlamydia infection would the nurse include when providing education for a female client?

1. Sterility 2. Ectopic pregnancy 3. Blocked fallopian tubes 4. Pelvic inflammatory disease 5. increased likelihood of HIV infection

Where on the maternal abdomen would the nurse place the fetal heart transducer when the fetus is in the left sacrum anterior position?

Left upper quadrant The left sacrum anterior position indicates that the fetus is in a breech presentation and the head is in the funds; fetal heart sounds are best heard in the left upper quadrant. Fetal heart sounds will be in the left lower quadrant if the fetus is in the left occiput anterior position. Fetal heart sounds will be in the right upper quadrant if the fetus is in the right sacrum anterior position. The fetal heart sounds will not be heard in the midline part of a lower quadrant in a single-fetus pregnancy.

Which changes would the nurse include in the childbirth class focusing on the maternal psychologic and physiologic alterations that occur near the end of pregnancy?

-Nesting needs increase -anxiety about childbirth increases -gastrointestinal motility decreases

The nurse is caring for a pregnant client at 28 weeks' gestation suspects intimate partner violence. Which assessment supports this suspicion?

-The client has injuries to the breasts and abdomen. -The partner answers questions that are asked of the woman. -The client has visited the clinic several times in the past month.

Place in order the steps the public-health nurse completes when using an evidence-based practice approach to identify the best model of care for pregnant women who use substances during pregnancy?

1. Ask a question such as "Does the use of community health workers improve outcomes for mothers who use substances during their pregnancy and their infants?" 2. Review the literature using key terms such as substance use, pregnancy, and models of care to find relevant evidence. 3. Appraise the importance of the evidence found; will it improve care outcomes? 4. Integrate the evidence found with own clinical expertise and values of the mothers in the target population. 5. Implement and evaluate the practice change.

Which activities would be taught by the nurse as methods of relieving back pain in pregnancy?

1. Pelvic rocking 2. Forward tilting 3. Sacral pressure