Antepartum AQ
During a physical examination in the prenatal clinic the client's vaginal mucosa is noted to have a purplish discoloration. Which sign should the nurse document in the client's clinical record? Hegar Goodell Chadwick Braxton Hicks
Chadwick (A purplish coloration, called the Chadwick sign, results from the increased vascularity and blood vessel engorgement of the vagina. The Hegar sign is softening of the lower uterine segment. The Goodell sign is softening of the cervix. After the fourth month of pregnancy, irregular, painless uterine contractions, called Braxton Hicks contractions, can be felt through the abdominal wall.)
A nurse teaches the warning signs that should be reported throughout pregnancy. Which statement by the client indicates an understanding of the prenatal instructions? "I'll call the clinic if I have abdominal pain." "Mild, irregular contractions mean that my labor is starting." "I need to call the clinic if my ankles start to swell at night." "A whitish vaginal discharge means that I'm getting an infection."
"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 at night 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.)
A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation would the nurse expect this clinical finding to occur? 8th week of pregnancy 10th week of pregnancy 12th week of pregnancy 18th week of pregnancy
12th week of pregnancy (By the 12th week of pregnancy the fetus and placenta have grown, expanding the size of the uterus. The enlarged uterus extends into the abdominal cavity. Between the 8th and 10th weeks of pregnancy, the uterus is still within the pelvic area. At the 18th week of pregnancy, the uterus has already risen out of the pelvis and is extending farther into the abdominal area.)
Which prenatal teaching is most applicable for a client who is between 13 and 24 weeks' gestation? Infant care, travel to the hospital, and signs of labor Growth of the fetus, personal hygiene, and nutritional guidance Interventions for nausea and vomiting, urinary frequency, and anticipated care Danger signs of preeclampsia, relaxation breathing techniques, and signs of labor
Growth of the fetus, personal hygiene, and nutritional guidance (Awareness of the fetus as an individual and the expected changes of pregnancy lead the client to seek information regarding fetal growth, body changes, and nutrition. Information on infant care, travel to the hospital, signs of labor, signs of preeclampsia, and relaxation breathing techniques is appropriate in the last trimester. Interventions for nausea and vomiting, urinary frequency, and anticipated care are appropriate for the first trimester.)
During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action? Seeking a psychology referral Explaining the danger this poses to the fetus Obtaining a prescription for an iron supplement Determining whether the diet is nutritionally adequate
Determining whether the diet is nutritionally adequate (The primary concern for a pregnant women who practices pica is that her diet is nutritionally inadequate. Nutritional guidance may be necessary, depending on the findings of this assessment. Pica does not indicate a psychologic/emotional disturbance; frequently it is influenced by the client's culture. If a substance is not toxic to the mother, it is generally not fetotoxic. Iron is routinely prescribed during pregnancy; this does not specifically address the practice of pica.)
A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of which month? Fifth month Third month Fourth month Second month
Third month (Because of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the first trimester. Morning sickness usually ends at the end of the third month, not the second month, when the chorionic gonadotropin level falls. It is still present in the second month because of the high level of chorionic gonadotropin, but has usually diminished by the fifth month.)
During a routine 32-week prenatal visit, a client tells the nurse that she has had difficulty sleeping on her back at night. Which guidance should the nurse provide regarding sleeping position? "Turn from side to side." "Try to sleep on your stomach." "Elevate the head of the bed on blocks." "Place two pillows under your knees for sleep."
"Turn from side to side." (The side-lying position will relieve back pressure; it also promotes uterine perfusion and fetal oxygenation. At 32 weeks' gestation the abdomen is too distended for the pregnant woman to lie in the prone position. Elevating the head of the bed will not relieve back pressure; it is used to limit gastroesophageal reflux. Lying on the back is contraindicated because it puts pressure on the vena cava, resulting in hypotension and uteroplacental insufficiency. Pillows under the knees are contraindicated because they place pressure on the popliteal area, which compresses the venous circulation, increasing the risk of thrombophlebitis.)
A 24-year-old client who has performed a positive home pregnancy test has presented at her first prenatal visit. She is 5 feet 6 inches tall (168 cm) and weighs 130 lb (59 kg). What should the nutrition plan regarding her daily caloric intake include? 100 more calories during the first trimester 540 more calories during the third trimester 300 more calories during the three trimesters 340 more calories during the second trimester
340 more calories during the second trimester (An extra 340 calories per day during the second trimester is the recommended caloric increase for adult women who are of average weight; this increase will meet the nutritional needs of both fetus and mother during the second trimester. The caloric intake during the first trimester should be about the same as in the nonpregnant state. The increase in caloric intake should be about 460 calories in the third trimester. Caloric needs, as well as caloric intake, vary from trimester to trimester, depending on fetal/maternal energy needs.)
At 22 weeks' gestation a client visits the prenatal clinic for the first time. As part of the prenatal workup, the client has blood work performed. The nurse concludes that further assessment is indicated when the laboratory findings show what? Hemoglobin of 10 g/dL (100 mmol/L) Sedimentation rate of 15 mm/hr Blood glucose level of 115 mg/dL (2.98 mmol/L) White blood cell (WBC) count of 9000/mm3
Hemoglobin of 10 g/dL (100 mmol/L) (A hemoglobin reading below 11 g/dL (110 mmol/L) suggests true anemia rather than physiologic anemia; this occurs because the plasma volume increases more than the red blood cell count during pregnancy, especially during the second trimester. The normal sedimentation rate in women is up to 20 mm/hr; no further assessment is necessary because this is an expected value. The normal blood glucose level ranges from 70 to 105 mg/dL (4.0-6.0 mmol/L); a slightly increased level is common during pregnancy. A WBC count of 5000 to 10,000/mm3 is within expected limits; no further assessment is necessary.)
A 38-year-old client attends the prenatal clinic for the first time. A nurse explains that several tests will be performed, one of which is the serum alpha-fetoprotein test. The client asks what the test will reveal. What should the nurse include in the reply? Trisomy 21 Turner syndrome Open neural tube defects Chromosomal aberrations
Open neural tube defects (An increased level of alpha-fetoprotein (AFP), a fetal serum protein, has been found to reflect open neural tube defects such as spina bifida and anencephaly. Trisomy 21 is revealed by genetic testing of fetal cells. Genetic studies will reveal the presence of just one X chromosome in a female child. Genetic testing, not AFP testing, will reveal chromosomal aberrations.)
A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client regarding sexual activity? Condoms must be used when the couple is having intercourse. Sexual abstinence should be practiced during the last 6 weeks of pregnancy. It will be necessary to refrain from sexual contact during pregnancy. Meticulous cleaning of the vaginal area after intercourse is essential.
Sexual abstinence should be practiced during the last 6 weeks of pregnancy. (Abstinence during the 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth. Because the herpes virus is smaller than the pores of a condom, this type of protection has limited effectiveness. Abstinence is necessary only when disease symptoms are present in the partner and during the last 4 to 6 weeks of pregnancy. Washing is not sufficient to prevent contraction of this virus; contact already has been made.)
A 23-year-old primigravida is at her first prenatal appointment today. Ultrasound indicates that she is at 9 weeks' gestation. She asks when she can first expect to feel her baby move. What is the best response by the nurse? "You should be able to feel the baby move any day now." "You should feel your first light movement of the baby around 24 weeks." "Most women can first detect movement of their babies by 12 to 14 weeks." "Many women are able to first feel light movement between 18 and 20 weeks."
"Many women are able to first feel light movement between 18 and 20 weeks." (Fetal movement can be felt after 18 weeks and usually by 20 weeks in a primigravida. Fetal movement is normally not felt before 18 weeks' gestation, when the uterus has risen into the abdomen. Fetal movement should continue to be felt at 24 weeks' gestation, but normally is felt 4 to 6 weeks before this time.)
While conducting prenatal teaching, the nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? Decreased metabolic rate Increased production of estrogen Secretion from the Bartholin glands Supply of sodium chloride to the vaginal cells
Increased production of estrogen (Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. Increased (not decreased) metabolism leads to systemic changes, but does not increase vaginal discharge. The amount of secretion from the Bartholin glands, which lubricates the vagina during intercourse, remains unchanged during pregnancy. There is no additional supply of sodium chloride to the vaginal cells during pregnancy.)
The nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain to the class? Select all that apply. Systemic vasodilation Increased blood volume Increased blood pressure Increased cardiac output Enlargement of the heart Decreased erythrocyte production
Increased blood volume Increased cardiac output Enlargement of the heart (Blood volume increases to meet the metabolic demands of pregnancy. Increased cardiac output is necessary to accommodate the increased blood volume needed to meet the demands of the growing fetus. Cardiac hypertrophy is a result of the demands made by the increased blood volume and cardiac output. Systemic vasodilation is not expected. There is little variation in blood pressure, but a slight decrease during the second trimester. Erythrocyte production increases; because the plasma volume increases more than the red blood cell count, the hematocrit is lower.)
The prenatal nurse palpates the uterus of a client who is at 12 weeks' gestation. The uterus is enlarged as expected. What else does the nurse determine about the uterus? It is just above the symphysis pubis. It is buried deep in the pelvic cavity. It is three fingerbreadths above the symphysis pubis. It is causing noticeable bulging of the abdominal wall.
It is just above the symphysis pubis. (At 12 weeks' gestation the enlarging uterus begins to rise out of the pelvis and is palpable just above the symphysis pubis. During the early weeks of gestation the uterus remains in the pelvic cavity. Usually this occurs at about 16 weeks' gestation. The noticeable bulging of the abdominal wall occurs later than 12 weeks' gestation when the fundus rises completely from the pelvis and enters the abdominal cavity.)
On a routine prenatal visit, what is the sign or symptom that a healthy primigravida at 20 weeks' gestation will most likely report for the first time? Quickening Palpitations Pedal edema Vaginal spotting
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 physically active 19-year-old primigravida attends the prenatal clinic for the first time. She asks the nurse whether she may continue playing tennis and riding horses while she is pregnant. How should the nurse reply? "Continue your usual activities as long as you are comfortable." "Horseback riding is acceptable, but only up to the last trimester." "Tennis is good exercise for you, but horseback riding is too strenuous." "Both of these sports have been found to be too strenuous for a pregnant woman."
"Continue your usual activities as long as you are comfortable." (Any regular activity that was typical before pregnancy may be safely continued in pregnancy if there are no complications such as bleeding, cramps, or pain. It is not necessary to stop riding after the second trimester unless the woman is uncomfortable or it is otherwise contraindicated. A woman used to riding horses may continue doing so—no exercise is too strenuous if it was done consistently before pregnancy—so both tennis and riding are acceptable as long as the woman is accustomed to doing them.)
A client on her first prenatal clinic visit is at 6 weeks' gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond? "What activities does your job entail?" "How do you feel about continuing to work?" "Most women work throughout their pregnancies." "Usually women quit work at the start of their third trimester."
"What activities does your job entail?" (More information is needed before the nurse can give a professional response. Although it is important to ascertain the client's feelings about continuing to work, at this time she is seeking information. Although it is true that most women work throughout their pregnancies, more information is needed before the nurse can respond. It is misinformation to state that usually women quit work at the start of the third trimester.)
During a prenatal examination the nurse draws blood from an Rh-negative client. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus is at risk for what? Acute hemolytic anemia Respiratory distress syndrome Protein metabolism deficiency Physiological hyperbilirubinemia
Acute hemolytic anemia (When an Rh-negative woman carries an Rh-positive fetus, there is a risk for the formation of maternal antibodies against Rh-positive blood; antibodies cross the placenta and destroy the fetal red blood cells. Determination of the lecithin/sphingomyelin ratio or the phosphatidylglycerol test, not the Rh factor, may provide information regarding the risk for respiratory distress syndrome (RDS). Testing for the Rh factor will not provide information about protein metabolism deficiency. Physiological bilirubinemia is a common occurrence in newborns; it is not associated with the Rh factor.)
A pregnant woman tells the nurse in the prenatal clinic that she knows that folic acid is very important during pregnancy and that she is taking a prescribed supplement. She asks the nurse which foods contain folic acid (folate) so she may add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply. Beef and fish Milk and cheese Chicken and turkey Black and pinto beans Enriched bread and pasta
Black and pinto beans Enriched bread and pasta (Legumes contain large amounts of folate, as do enriched grain products. Beef and fish do not contain adequate amounts of folate. Milk and cheese do not contain adequate amounts of folate; nor does fowl.)
A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to the primary healthcare provider with the mother. Which signs and symptoms require further evaluation by the primary healthcare provider? Select all that apply. Decreased urine output Blurred vision with spots Urinary frequency without dysuria Heartburn after eating a fatty meal Contractions that are regular and 5 minutes apart Shortness of breath after climbing a flight of stairs
Decreased urine output Blurred vision with spots Contractions that are regular and 5 minutes apart (Decreased urine output, blurred vision, and severe headache may occur with pregnancy-associated hypertension. Contractions that become regular are associated with the onset of labor. Preparatory (Braxton Hicks) contractions ease when the client walks. Urinary frequency occurs in the first trimester and again in the third trimester as the uterus settles back into the pelvis. The weight of the uterus may delay emptying of the stomach and make heartburn a more frequent problem. Shortness of breath would be expected after the client climbs a flight of stairs.)
A client starting her second trimester asks a nurse in the prenatal clinic whether she can safely take an over-the-counter medicine. The nurse explains why she should consult with her primary healthcare provider before taking any oral medications. What physiologic alteration associated with pregnancy may change the client's response to medication? Decreased glomerular filtration rate Longer gastrointestinal emptying time Increased secretion of hydrochloric acid Development of fetal-placental circulation
Longer gastrointestinal emptying time (Gastrointestinal motility is reduced during pregnancy because of the high level of placental progesterone and displacement of the stomach superiorly and the intestines laterally and posteriorly; absorption of some drugs, vitamins, and minerals may be increased because of their slow passage through the gastrointestinal tract. The glomerular filtration rate increases during pregnancy. The amount of gastric secretion is somewhat lower in the first and second trimesters; it increases in the third trimester. The development of fetal-placental circulation is unrelated to the absorption of drugs.)
A client visits the prenatal clinic for the first time. The client tells the nurse that her last menstrual period began June 10. The nurse uses the Nägele rule to calculate the EDB. What is the EDB? April 7 March 7 April 10 March 17
March 17 (The EDB is March 17. Using the Nägele rule, subtract 3 months and add 1 year and 7 days to the first day of the last menstrual period. April 7, March 7, and April 10 all represent inaccurate applications of the Nägele rule.)
A client asks the nurse at the prenatal clinic whether she may continue to have sexual relations while pregnant. What is one indication that the client should refrain from intercourse during pregnancy? Fetal tachycardia Presence of leukorrhea Premature rupture of membranes Imminence of the estimated date of birth
Premature rupture of membranes (Ruptured membranes leave the products of conception exposed to bacterial invasion. Intact membranes act as a barrier against organisms that may cause an intrauterine infection. Fetal tachycardia may occur during sex, but there is no evidence that it is harmful for the fetus. Leukorrhea is common because of increased production of mucus containing exfoliated vaginal epithelial cells; intercourse is not contraindicated by leukorrhea. Intercourse is not contraindicated near the estimated date of birth if the membranes are intact; modification of sexual positions may be needed because of the enlarged abdomen.)
A pregnant woman at 6 weeks' gestation tells the nurse at her first prenatal visit that she uses an over-the-counter herbal product as a health supplement. What should the nurse recommend to the client? Select all that apply. Stop taking the supplement immediately. Discuss the use of the supplement with the practitioner. Increase the dosage of the supplement as pregnancy progresses. Ask the pharmacist whether the supplement is safe for use during pregnancy. Discuss the use of any over-the-counter products with the practitioner.
Stop taking the supplement immediately. Discuss the use of the supplement with the practitioner. Discuss the use of any over-the-counter products with the practitioner. (Stopping the supplement is appropriate until more instructions are received from the practitioner. It is the practitioner's responsibility to counsel the client regarding all prescriptions, over-the-counter medications, and supplements. Continuing or increasing the dose of the supplement is unsafe; it may be detrimental to both the client and the fetus. The nurse may not prescribe medications of any kind, and to do so is functioning outside of the legal definition of nursing practice. It is the practitioner's responsibility, not the pharmacist's, to counsel the client regarding all prescriptions, over-the-counter medications, and supplements.)
A primigravida in her first trimester visits the prenatal clinic for the first time. Which statement illustrates a psychologic reaction to pregnancy that usually occurs in the first trimester? "I know I'm going to be a terrible mother—I'll forget the baby when I go out." "I'm excited about the baby, but I'm not sure that I'm ready to be a mother." "I know I'm going to have a girl. I dreamed that she would be a doctor or a lawyer and be very successful." "I'm so excited about this baby, but I'm so afraid of losing control during labor. I know I'll be a terrible patient."
"I'm excited about the baby, but I'm not sure that I'm ready to be a mother." (The response "I'm excited about the baby, but I'm not sure that I'm ready to be a mother" reflects the ambivalence about the pregnancy that is typical during the first trimester. The statement "I know I'm going to be a terrible mother—I'll forget the baby when I go out" is a typical response during the third trimester, when the client begins to doubt her ability to be a good parent. Fantasizing about the infant, its sex, and its future is common during the second trimester. Expressing fears about the birthing process and parenting is common during the third trimester.)
A pregnant client in the third trimester tells the nurse in the prenatal clinic that she is experiencing heartburn after every meal. Which explanation should the nurse provide regarding the cause of the heartburn? "The esophageal sphincter relaxes and allows acid to be regurgitated." "In pregnancy, gastric motility increases, causing a burning sensation." "In pregnancy, gastric pH increases, causing acid to enter the esophagus." "In pregnancy, the pyloric sphincter relaxes, allowing acid to enter the intestine."
"The esophageal sphincter relaxes and allows acid to be regurgitated." (Relaxation of the esophageal sphincter, resulting in regurgitation of acid, causes heartburn (pyrosis) during the second half of pregnancy. Delayed emptying of stomach contents because of decreased gastric motility and displacement of the stomach because of uterine enlargement contribute to the problem. Gastric motility is decreased during pregnancy. When gastric pH increases, gastric juices become more alkaline, leaving little or no acid to be regurgitated into the esophagus. The pyloric sphincter does not relax, and acid does not pass into the small intestine.)
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 should the nurse recommend? Select all that apply. Focus on and repeat a rhythmic chant. Sit upright for 30 minutes after meals. Take low-sodium antacids after meals. Drink carbonated beverages with meals. Eat small, frequent meals and eat dry crackers in between.
Focus on and repeat a rhythmic chant. Eat small, frequent meals and eat dry crackers in between. (Focusing helps mitigate odors, tastes, and thoughts that may cause nausea. Avoiding an empty stomach decreases the occurrence of nausea associated with pregnancy. Sitting upright after meals will help ease heartburn, but will have little effect on nausea. Prescribed low-sodium antacids may be taken between meals later in pregnancy to promote relief from heartburn. Carbonated beverages may or may not help; however, women should be advised to consume fluids between, not with, meals.)
A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her? Rubella (measles) Rubeola (German measles) Inactive influenza Varicella (chicken pox)
Inactive influenza (The inactive influenza and diphtheria, tetanus, pertussis (dTAP) immunizations can be safely administered during the first trimester of pregnancy, although dTAP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant. The inactivated influenza vaccine may be given because it is a killed virus vaccine and will not have a teratogenic effect. Rubella (measles) and rubeola (German measles) vaccines are both live viruses that should never be administered during pregnancy because they can have teratogenic effects. Varicella (chicken pox) immunization is not given because it may cause birth defects in the fetus.)
A woman visits the prenatal clinic because an over-the-counter pregnancy test has rendered a positive result. After the initial examination verifies the pregnancy, the nurse explains some of the metabolic changes that occur during the first trimester of pregnancy. What should the nurse include? Select all that apply. Sleep needs increase Urinary frequency Body temperature decreases Calcium requirements remain the same The need for carbohydrates decreases
Sleep needs increase Urinary frequency Calcium requirements remain the same (Estrogen increases the secretion of corticosteroids, which decrease the basal metabolic rate, resulting in fatigue. Sodium is retained. Urinary frequency occurs. During the first trimester approximately 1000 mg of calcium is needed each day. There is no longer a recommendation for an increase in daily calcium intake during pregnancy and lactation. The daily recommended intake of 1000 mg for women older than 19 years and 1300 mg for women younger than 19 years is adequate for fetal bone and tooth development. Body temperature increases because of the increased metabolism related to the growth of the fetus. Carbohydrate needs increase because the secretion of insulin by the pancreas is increased; however, insulin is destroyed rapidly by the placenta. The stress of pregnancy may precipitate gestational diabetes.)
