Chapter 12 Nursing Management During Pregnancy

A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that is not necessary and schedules a second ultrasound to be performed when is about: A) 15 to 17 weeks pregnant B) 21 to 23 weeks pregnant C) 24 to 26 weeks pregnant D) 18 to 20 weeks pregnant

D) 18 to 20 weeks pregnant There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.

A young couple are concerned that their fetus may be born with sickle cell anemia. The nurse explains that the recessive traits of sickle-cell anemia can be determined by using which test? A) percutaneous umbilical blood sampling B) bloody typing C) amniocentesis D) chorionic villus sampling

D) chorionic villus sampling Chorionic villus sampling (CVS) is a procedure for obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, fetal gender determination, and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay-Sachs disease. Amniocentesis is used to evaluate for neural tube defects, chromosomal disorders, and born errors of metabolism. Blood typing performed via a blood sample. Percutaneous umbilical blood sampling allows for rapid chromosomal analysis.

After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client makes which statement? A) "I'll sit comfortably in a recliner or lie on my side when I do the counts" B) "I'll do the count once a week on a morning that I'm not rushed for work" C) "I'll do the counts while I'm sitting and watching my son's basketball game" D) "I won't expect more than three movements to happen in an hour"

A) "I'll sit comfortably in a recliner or lie on my side when I do the counts" The client should perform the counts in a relaxed environment and a comfortable position, such as a semi-Fowler's or side-lying position. The woman needs to do fetal movement counts consistently, at approximately the same time each day. A woman should report a count of less than three fetal movements in an hour. A relaxed environment, a comfortable position, and consistency in performing the counts are important to identify changes.

A pregnant woman who has come to the clinic for an evaluation is scheduled to undergo nuchal translucency screening. The woman asks the nurse, "What is this test all about?" Which response(s) by the nurse would be appropriate? Select all that apply. A) "The provider will check the amount of fluid in the space behind your fetus's neck" B) "You will have an ultrasound done to check for chromosomal problems" C) "This test involves an amniocentesis to check for genetic abnormalities" D) "A needle is inserted into your belly to get a sample of cells from the placenta" E) "You will have blood drawn to check for substances associated with abnormalities"

A) "The provider will check the amount of fluid in the space behind your fetus's neck" B) "You will have an ultrasound done to check for chromosomal problems" Nuchal translucency screening is an ultrasound that is done in the first trimester between 11 to 14 weeks' gestation. This allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities. It measures fluid collection in the subcutaneous space between he skin and the cervical spine of the fetus. Blood sampling may be done to check for maternal markers that could indicate problems. Amniocentesis involves a trans abdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before brith. In addition, amniocentesis is used to confirm a fetal abnormality when other screening tests detect a possible problem. Chorionic villus sampling (CVS) is an invasive procedure involving an 18-gauge needle stick through the abdomen or passage of a suction catheter through the cervix under ultrasound guidance. This test is used to obtain a sample of the chorionic villi from the placenta for prenatal evaluation of chromosomal disorders such as Down syndrome or cystic fibrosis, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay-Sachs disease.

A client at 10 weeks gestation comes to the clinic for a prenatal follow up. The client reports experiencing morning sickness. She states, "It happens at any time of the day. Is there anything I can do?" Which suggestions by the nurse would be most helpful? Select all that apply. A) "limit your intake of fluids when you eat your meals" B) "try eating some dry crackers before you getting out of bed in the morning" C) "limit the number of meals to 2 meals per day" D) "avoid any strong food odors as much as possible" E) "eat a high-fat snack before going to bed at night"

A) "limit your intake of fluids when you eat your meals" B) "try eating some dry crackers before you getting out of bed in the morning" D) "avoid any strong food odors as much as possible" Measures to help alleviate nausea and vomiting of pregnancy include eating small, frequent meals that are bland and low in fat, eating dry crackers, Cheerios, or cheese before getting out of bed, avoiding any strong food odors, limiting the intake of fluids and soups during meals, and eating a high-protein snack before going to bed.

At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1c above which level is concerning for diabetes and warrants further testing? A) 6.50% B) 5.00% C) 6.00% D) 5.50%

A) 6.50% A hemoglobin A1c level of at least 6.5% is concerning for overt diabetes and further testing should be conducted to ensure the client is not diabetic. If glucose testing is not diagnostic of overt diabetes, the woman should be tested for gestational diabetes from 24 to 28 weeks of gestation with a 75-gm oral glucose tolerance test.

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects? A) alpha-fetoprotein analysis B) amniocentesis C) triple-marker screen D) doppler flow study

A) alpha-fetoprotein analysis Alpha-fetoprotein is a substance produced by the fetus. AFP enters the maternal circulation by crossing the placenta. If there is a developmental defect, more AFP escapes into amniotic fluid from the fetus. The optimal time for AFP screening is 16 to 18 weeks. The triple marker screens for AFP, hCG, and unconjugated estriol. This screens for neural defects and Down syndrome. The doppler flow study evaluates the blood flow, and amniocentesis evaluates the contents of amniotic fluid looking for chromosomal defects.

Encouraging routine prenatal visits is an important function for nurses to ensure the clients avoid complications or difficulties throughout the pregnancy and birth. The nurse would prepare to screen clients for gestational diabetes at which time during the pregnancy? A) between 24 and 28 weeks' gestation B) between 15 and 19 weeks' gestation C) between 29 and 32 weeks' gestation D) between 20 and 24 weeks' gestation

A) between 24 and 28 weeks' gestation Screening for gestational diabetes is best done between 24 and 28 weeks' gestation, unless screening is warranted in the first trimester for high-risk reasons. If the initial screening is elevated, then further testing should be conducted to confirm the diagnosis

A client is in her second trimester, and the health care provider has recommended she undergo an amniocentesis. The nurse explains that the procedure is used to diagnose which conditions? Select all that apply. A) chromosomal abnormalities B) neural tube defects C) inborn errors of metabolism D) Rh incompatibility E) HIV

A) chromosomal abnormalities B) neural tube defects C) inborn errors of metabolism Amniocentesis is performed in the second trimester, usually between 15 and 18 weeks gestation. Over 40 different chromosomal abnormalities, inborn errors of metabolism, and neural tube defects can be diagnosed with amniocentesis. It can replace a genetic probability with a diagnostic certainty, allowing the woman and her partner to make an informed decision about their options. Rh incompatibility and HIV status are both evaluated by blood tests.

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur? A) fetal tachycardia B) rebound maternal hypothermia C) membrane rupture D) urinary incontinence

A) fetal tachycardia Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tube use.

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply. A) lower abdominal pain with shoulder pain in the first trimester B) backache during the second trimester C) sudden leakage of fluid during the second trimester D) urinary frequency in the third trimester E) nausea with vomiting during the first trimester F) headache with visual changes int he third trimester

A) lower abdominal pain with shoulder pain in the first trimester C) sudden leakage of fluid during the second trimester F) headache with visual changes in the third trimester Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea, and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.

When describing the role of a double to a group of pregnant women, the nurse would include which information? A) the doula primarily focuses on providing continuous labor support B) the doula is a professionally trained nurse hired to provide physical and emotional support C) the doula is capable of handling high-risk births and emergencies D) the doula can perform any necessary clinical procedures

A) the doula primarily focuses on providing continuous labor support Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

When providing preconception care to a client, which instruction would be most important for the nurse to provide about medications during pregnancy? A) "Herbal remedies are better to use than medicines" B) "You need to talk with your provider about using medications" C) "It's safer for you to take over-the-counter medications" D) "You need to avoid all medications when you're pregnant"

B) "You need to talk with your provider about using medications" Medication use is common during pregnancy, with prevalence estimates generally exceeding 65% and increasing over the years. Pregnant women use a wide variety of both prescription and OTC medications for both pregnancy-related conditions unrelated to pregnancy conditions. Little is known about the effects of taking most medications during pregnancy IT is best for pregnant women to not take any medications during their pregnancy. At the very least, they should be encouraged to discuss with the health care provider their current medications and any herbal remedies they take so that they can learn about any potential risks should they continue to take them during pregnancy. A common concern of many pregnant women involves the use of OTC medications and herbal agents. Many women consider these products bending simply because they are available without a prescription. Although herbal medications are commonly thought of as "natural" alternatives to other medicines, they can be just as potent as some prescription medications. The nurse should encourage pregnant women to check with their health care providers before taking anything.

A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information? A) the blood tests are definitive B) further testing will be required to confirm any diagnosis C) a second set of screening tests can be obtained to confirm results D) treatment can be started once the test results are back

B) further testing will be required to conform any diagnosis Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

Part of the initial prenatal assessment should include the client's immunization history. The nurse informs the client to avoid which type of vaccines while she is pregnant? A) inactivated virus vaccine B) live virus vaccine C) bacterial vaccine D) toxoid vaccine

B) live virus vaccine Routine immunizations are not usually indicated during pregnancy. However, no evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. A number of other vaccines have not been adequately studied. Advise pregnant women to avoid live virus vaccines (MMR and varicella) and to avoid becoming pregnant within one month of having received one of these vaccines because of the theoretical risk of transmission to the fetus.

A nurse is conducting a class with group of pregnant women who are all in their first trimester of pregnancy. During the class, the women are discussing the various discomforts that they are experiencing. The nurse would expect to hear reports about which discomforts? Select all that apply. A) backache B) nausea C) leg cramps D) urinary frequency E) breast tenderness

B) nausea D) urinary frequency E) breast tenderness Common discomforts associated with the first trimester include nausea, urinary frequency, and breast tenderness. Backache and leg cramps are more common in the second trimester.

A pregnant woman comes to the clinic for follow-up appointment. The woman had an amniocentesis on her previous visit. The nurse reviews the results from the testing. Which result(s) would the nurse identify as problematic? Select all that apply. A) glucose 35 mg/dl (1.94 mol/l) B) negative phosphatidylglycerol C) white flecks in clear fluid D) bilirubin positive E) lecithin-sphingomyelin (L/S) ratio greater than 2

B) negative phosphatidylglycerol D) bilirubin positive Abnormal results of an amniocentesis include positive bilirubin suggestive of hemolytic disease in the fetus and negative phosphatidylglycerol suggestive of pulmonary immaturity. In normal results, the fluid is clear with white flecks from vernix cases, the L/S ratio is greater than 2, and the glucose level is less than 45 mg/dl (2.50 mol/l)

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include? A) the importance of health lifestyle B) the use of OTC drugs with teratogens C) importance of taking adequate vitamin and mineral supplements D) family history of pregnancy complications

B) the use of OTC drugs with teratogens Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? A) at 32 weeks B) at 36 weeks C) only at birth D) at 28 weeks

D) at 28 weeks If indicated, Rho(D) immune globulin should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+

A nurse is reading a journal article about the use of real-time ultrasonography, which allows the health care provider to obtain information about the fetus. The nurse would expect the article to describe which type of information? A) the size and shape of placenta B) the effectiveness of neural tube defect treatment C) chromosomal abnormalities D) biophysical profile

D) biophysical profile A biophysical profile uses real-time ultrasound to allow assessment of various parameters of fetal well-being. This may include fetal movements, fetal tone, and fetal breathing, as well as assessment of amniotic fluid volume with or without assessment of fetal heart rate. Chromosomal abnormalities are detached via amniocentesis. Neural tube defect treatment is not evaluated via biophysical profile, and although the placenta may be observed, it is not the focus of this procedure.

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicated the need for additional teaching? A) "I'll increase my time spent on walking each day" B) "I'll switch to chewing gum instead of using mints" C) "I'll try to drink more fluids to help move things along" D) "I'll stay away from foods like cabbage and Brussel sprouts"

B) "I'll switch to chewing gum instead of using mints" Eating mints can help reduce flatulence; chewing gum increases the amount of air that is swallowed, increasing gas build-up. Increasing fluid intake helps to reduce flatus. Gas-forming foods such as beans, cabbage, and onions should be avoided. Increasing physical exercise, such as walking, aids in reducing flatus.

At the first prenatal visit, the client reports her LMP was November 16, 2019. The nurse determines the estimated due date to be? A) September 1, 2020 B) August 23, 2020 C) August 13, 2020 D) August 3, 2020

B) August 23, 2020 There are several methods to determine the EDB. Nagele's rule can be used, which involves subtracting 3 months and then adding 7 days to the first day of the LMP. Then correct the year by adding 1 where necessary. Another method is to add 7 days and then add 9 months and add 1 to the year where needed. Thus the client reports her LMP was Nov 16, 2019, subtract 3 months (August), add 7 days (23), and add 1 year (2020). The client's EDB is August 23, 2020.

At her prenatal visit a client reports that she cannot find any shoes that are comfortable. Assessment of her legs reveals dependent edema. The nurse suggests that the client attempt which actions to help reduce the edema? Select all that apply. A) wear knee-high support stockings B) elevate feet and legs when sitting or lying C) drink 6 to 8 glasses of water each day D) avoid foods high in sodium, sugar, and fats E) when lying down, lie on the right side

B) elevate feet and legs when sitting on lying C) drink 6 to 8 glasses of water each day D) avoid foods high in sodium, sugar, and fats Dependent edema is usually the result of pressure put on the veins preventing adequate blood flow to return to the heart. Appropriate suggestions to reduce dependent edema include elevating feet and legs when sitting or lying down; avoiding foods that are high in sodium, sugar, and fats; drinking at least 6 to 8 glasses of water per day; avoid wearing knee-high stockings; and lying on the left side to keep the gravid uterus off the vena cava to return blood to the heart.

A pregnant woman in her second trimester comes to the clinic for a follow-up. During the visit, the woman reports discomfort related to hemorrhoids. Which suggestion(s) would be appropriate for the nurse to include when teaching the woman about relief measures. Select all that apply. A) "Avoid exercising when you are having discomfort" B) "Take a sitz bath using cool or cold water" C) "Be sure to drink at least 2 L of fluid each day" D) "Try using some cold compresses to the area" E) "Raise your feet on a stool when having a bowel movement"

C) "Be sure to drink at least 2 L of fluid each day" D) "Try using some cold compresses to the area" E) "Raise your feet on a stool when having a bowel movement" For hemorrhoid relief, it would be important to instruct the client in measures to prevent constipation, including increasing fiber intake and drinking at least 2 L of fluid per day. The nurse should also teach the client about local comfort measures such as warm sitz baths, witch hazel compresses, or cold compresses. To minimize the client's risk of straining while defecating, the nurse should suggest that she elevates her feet on a stool, and also encourage her to avoid prolonged sitting or standing. Engaging in exercise can help to reduce the risk for constipation which would lead to straining.

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with heartburn. The nurse determines a need for additional teaching based on which client statement? A) "I need to raise the head of my bed about 15 to 30 degrees" B) "I need to cut out caffeine" C) "I should lie down for 1/2 hour after eating" D) "I should chew my food slowly"

C) "I should lie down for 1/2 hour after eating" The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing heartburn of pregnancy.

A woman is 20 weeks pregnant. The nurse would expect to palpate the funds at which location? A) symphysis pubis B) just below the ensiform cartilage C) at the umbilicus D) between the symphysis and umbilicus

C) at the umbilicus At 20 weeks, the funds can be palpated at the umbilicus. A funds of 12 weeks' gestation is palpated at the symphysis pubis. At 16 weeks' gestation, the funds is midway between the symphysis pubis and umbilicus . At 36 weeks' gestation, the funds can be palpated just below the ensiform cartilage.

A nurse is providing care to a pregnant client who is 9 weeks gestation. The client reports that her breasts have become quite tender. She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply. A) oxytocin B) prolactin C) progesterone D) hCG E) estrogen

C) progesterone E) estrogen An increase in estrogen and progesterone that occurs with pregnancy causes the fat layer of the breasts to thicken and the number of mild ducts and glands to increase during the first trimester. Oxytocin stimulates uterine contractions. Prolactin stimulates breast milk production. hCG is the hormone that confirms pregnancy.

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem? A) 13.5 cm B) 12.5 cm C) 13.0 cm D) 12.0 cm

D) 12.0 cm The diagonal conjugate, usually 12.5 cm or greater, indicated the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks

D) 4 weeks The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.

A nurse is teaching a pregnant woman how to perform fetal kick counts. The nurse determines that the teaching was successful when the client states that she will call her healthcare provider if it takes longer than what time frame to reach 10 kicks? A) 1 hour B) 3 hours C) 2 hours D) 4 hours

C) 2 hours The most common method of kick counting is "Count to 10" whereby a woman focuses her attention on her fetus's movement and records how long it takes to document 10 movements. If it takes longer than 2 hours, the woman should contact her health care provider for further evaluation.