ANTEPARTUM
Answer: B, C Explanation: A) Nearly all fish contain traces of mercury. Mercury can place the developing nervous system of the fetus at risk and cause negative effects on cognitive functioning. The nurse should instruct the client to eat up to 12 ounces a week of a variety of fish and shellfish. The nurse should advise the client to eat no more than 6 ounces of albacore tuna each week because it has more mercury than other canned tuna. King mackerel should be avoided because it contains high levels of mercury. The nurse should not suggest that the client consume a complete vegetarian diet because this could lead to other nutritional deficiencies. The nurse should encourage the client to consume shrimp, salmon, and catfish, because these fish have the least amount of mercury.
1) A client who recently learned of being pregnant tells the nurse that she stopped eating meat years ago and started eating fish daily because it is healthier. Which teaching points are appropriate for this client based on her current diet? Select all that apply. A) Avoid shrimp, salmon, and catfish because these have higher mercury levels. B) Eat up to 12 ounces a week of a variety of fish and shellfish. C) Do not eat more than 6 ounces per week of albacore tuna. D) Eat plenty of fish such as king mackerel while pregnant. E) Follow a complete vegetarian diet while pregnant as an alternative to eating fish.
Answer: D Explanation: A) Although all of these clients will need special considerations related to diet and nutritional requirements, the client with anorexia nervosa, an eating disorder, is at highest risk for inadequate nutrition. When a pregnant woman has an eating disorder, education and individualized meal plans can help the patient increase her dietary intake while maintaining a sense of control.
10) Which pregnant client would have the greatest need for a nutritional assessment and individualized meal plan? A) A client who is lactose intolerant B) A client who is vegetarian C) A client who requires a Kosher diet D) A client with anorexia nervosa
Answer: A Explanation: A) A younger client may be more concerned about modesty than older clients, especially as her body changes and grows rapidly. Older adolescents who are pregnant may be more concerned about state marriage laws, parents finding out about the pregnancy, and finding a support person. Younger clients are more likely to involve parents in the early stages of pregnancy for both emotional and financial support.
11) The nurse is caring for a 14-year-old client who is pregnant. What will the nurse need to consider that may affect this client more than older adolescents? A) The client may be more concerned about modesty. B) The client may be more concerned with state marriage laws. C) The client may be more concerned about parents finding out about the pregnancy. D) The client may be more concerned about finding a support person.
Answer: A Explanation: A) Adolescent children, especially children from a previous marriage, may feel jealous that the new baby will take all the attention of the parent or fear that they will be asked to contribute to the newborn's care. The nurse should help the mother understand these feelings and encourage the mother to address these feelings with her older children. Telling the mother that the older children are just embarrassed and will get over it is inappropriate. Encouraging the mother to give newborn care responsibilities to the older children may make the issue worse. Discussing the role of stress and anxiety in improving relationships is more appropriate for a spouse, not older children.
12) The nurse is caring for a 36-year-old pregnant woman. She has two children, ages 15 and 13, from a previous marriage, and this is her first child from her second marriage. The client has indicated that her two older children seem very upset by her pregnancy and have been increasingly belligerent the closer she gets to delivery. What can the nurse say to support this family? A) "It may help to remind your older children that you will still make time for them and that you won't expect them be responsible for the baby unless they want to." B) "You could tell your older children that the stress and anxiety that comes with a new baby will help improve your family relationships." C) "They are probably just embarrassed because you are pregnant. They'll get over it once you have the baby." D) "Your older children probably just want to know what their new roles will be once the baby is born. You should tell them what their responsibilities will be in caring for the baby."
Answer: A Explanation: A) When teaching a pregnant client diagnosed with TB, the nurse will include information regarding medication administration. Isoniazid, which does cross the placenta but most studies show is not teratogenic, is often the drug of choice to treat TB during pregnancy. When taking isoniazid, the client will also need to take pyridoxine. If TB is active at delivery, the newborn should not have direct contact with the mother while she is infectious. This is not likely going to be the case, as the client is diagnosed early in the pregnancy. If maternal TB is inactive, the mother may breastfeed and care for her infant. Extra rest and limited contact with others are required until the disease becomes inactive.
2) A client at 16 weeks' gestation is diagnosed with tuberculosis (TB). Which statement by the nurse is appropriate when instructing the client regarding the needs for both the client and fetus? A) "You have been prescribed isoniazid; therefore, you must also take pyridoxine (vitamin B6)." B) "Your contact with the baby will be limited for several months after delivery." C) "You will not be able to breastfeed your baby because of this diagnosis." D) "You are free to have contact with anyone as TB is not contagious when diagnosed during pregnancy."
Answer: C Explanation: A) Of the three physiologic complaints, the one that has the highest priority is nausea because it could directly impact the developing fetus. Breast tenderness does not mean that the client will experience ineffective breastfeeding. Fatigue is a common symptom of pregnancy and would not negatively impact the developing fetus. The husband being upset with the client's complaints does not necessarily mean that she and her husband have dysfunctional family processes.
3) A client who is at 12 weeks' gestation is experiencing nausea, breast tenderness, and fatigue. She tells the nurse her husband is upset with her constant complaints. Which is the priority nursing diagnosis based on this data? A) Ineffective Breastfeeding B) Dysfunctional Family Processes C) Nausea D) Fatigue
Answer: D Explanation: A) Clients of European, African, and Mexican descent may believe that reaching over the head during pregnancy can harm the baby. The nurse should assure the client that this is not accurate. Providing activities to do instead of exercise or telling the client to avoid the exercises that require her to reach over her head will not address the misconception that reaching over the head will harm the baby. Dietary instruction during pregnancy is important to ensure a healthy weight gain for a healthy baby, not to ensure the client does not gain excessive weight because of lack of exercise.
4) The nurse is reviewing exercises with a pregnant woman to help the client maintain physical fitness and appropriate weight gain throughout the pregnancy. After the teaching session, the client tells the nurse that she was taught never to reach over the head because this will harm the baby. Based on this data, which action by the nurse is appropriate? A) Provide dietary instruction instead to ensure the client does not gain excessive weight. B) Tell the client to just perform the exercises that don't require her to reach over her head. C) Provide alternative activities to do instead of exercise. D) Assure the client that reaching over the head will not harm the baby.
Answer: C Explanation: A) Albuterol, a beta2-agonist, is the medication recommended to treat asthma exacerbations during pregnancy. Steroids, decongestants such as pseudoephedrine, and aspirin should be avoided in pregnancy because of potential harmful effects to the fetus.
9) The nurse is caring for a pregnant client who has asthma. The client has a cold and has an exacerbation of asthma symptoms, including mild wheezing. To help avoid hypoxia-related complications in the fetus, which medication prescription does the nurse anticipate? A) IV corticosteroid (e.g., prednisone) B) Oral pseudoephedrine (e.g., Sudafed) C) Inhaled beta2-agonist (e.g., albuterol) D) Oral acetylsalicylic acid (e.g., aspirin)
Answer: D Explanation: A) For couples having an amniocentesis, the first few months of pregnancy can be difficult because the test cannot be performed until the 14th week of pregnancy, and not before. The results of the amniocentesis will not be available for up to 2 weeks, which is evidence that instruction regarding the test has been understood by the client and spouse. Childbirth classes are important in promoting adaptation to the event of childbirth for expectant couples of any age or situation. The results of an amniocentesis are 99% accurate in diagnosing genetic abnormalities.
5) The nurse is providing care to a pregnant client and her spouse. The client requires an amniocentesis. Which client statement indicates appropriate understanding of the information presented? A) "The test has to be done before the 14th week of pregnancy." B) "If the test determines our baby has Down syndrome, we will not need to take childbirth classes." C) "It is not unusual for amniocentesis to misdiagnose a problem with the baby." D) "The results of the amniocentesis will take up to 2 weeks."
Answer: B Explanation: A) Ptyalism is excessive, often bitter salivation that can occur during pregnancy. Appropriate interventions for this client include using astringent mouthwashes, chewing gum, or sucking on hard candy. A cool-mist vaporizer and avoiding nasal sprays and decongestants are appropriate interventions for nasal stuffiness and nosebleed (epistaxis). The use of low-sodium antacids is appropriate for pyrosis, or heartburn.
6) The nurse is providing care to a pregnant client who is experiencing ptyalism. Which will the nurse include in the plan of care for this client? A) Use a cool-mist vaporizer B) Suck on hard candy C) Avoid use of nasal sprays and decongestants D) Use low-sodium antacids
Answer: A Explanation: A) The pelvic tilt or pelvic rock exercise helps prevent or reduce back strain, as it strengthens the abdominal muscles. The client with a history of back pain should be instructed to perform the exercise in the standing position only. Doing the exercise on the hands and knees may aggravate back strain and cause pain. Pregnant clients should be instructed to avoid exercising in the supine position after the first trimester because it could hinder uterine blood flow and harm the fetus. Pregnant clients should be instructed to avoid hot tubs because of the possible teratogenic effects of hyperthermia on the developing fetus.
7) The nurse is teaching childbirth exercises to a pregnant client with a history of back pain. Which is most appropriate for this client? A) Perform the pelvic rock exercise only in the standing position. B) Exercise in the supine position throughout the pregnancy. C) Perform the pelvic rock exercise while in the hands and knees position. D) Soak in a hot tub for approximately 30 minutes after exercise.
Answer: B, D Explanation: A) When providing care to a client with RA during pregnancy, the nurse will monitor the client for anemia due to salicylate therapy and educate the client that medication therapy may be discontinued if the client experiences remission during the pregnancy. Salicylate therapy is associated with prolonged gestation and labor. Supplemental pyridoxine is required for clients being treated with isoniazid for TB during pregnancy. RA cannot be contracted by the fetus during pregnancy.
8) The nurse is providing care to a client with a history of rheumatoid arthritis (RA) who is 5 months pregnant. Which nursing actions are appropriate when providing care to this client? Select all that apply. A) Telling the client there is an increased risk for preterm delivery because of salicylate therapy B) Monitoring the client for anemia due to salicylate therapy C) Suggesting the client begin supplemental pyridoxine D) Educating the client that medication therapy may be discontinued due to remission E) Teaching the client that RA may be contracted by the fetus during pregnancy
