Chapter 12: Nursing Management During Pregnancy

Which statement would indicate a pregnant nurse needs additional health teaching about avoiding teratogens during pregnancy while at work?

"I often go with my clients to the X-ray department." Explanation: Teratogens are agents or factors that cause harm to a fetus. It is recommended to avoid X-ray exposure, except dental, during pregnancy, because there is no safe dosage determined. Therefore, the pregnant nurse should be taught to avoid going to X-ray with their clients. To avoid exposure while working, nurses should always wear proper personal protection equipment, such as latex-free gloves, to prevent contact with blood and body fluids. Caring for multiple clients and giving emotional support do not increase exposure to teratogens.

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, the nurse understands that which client statement indicates the need for additional teaching?

"I'll switch to chewing gum instead of using mints." Explanation: 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.

A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response?

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow." Explanation: Increasing levels of progesterone cause relaxation of ligaments and joints. This allows the rib cage to flare to accommodate the enlarging uterus. As the uterus enlarges, it pushes up against the diaphragm. This changes respirations from abdominal to costal, and the woman feels short of breath. The nurse should never demean a client's symptoms. Oxygen requirements do increase during pregnancy, but this not the reason for the woman's shortness of breath.

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus?

"The gloves they provide irritate my hands, so I don't use them." Explanation: There are various chemicals which are recognized for their teratogenic effects and must be avoided during pregnancy. The nurse should find out which chemicals the client is exposed to and determine the risk factor. The greatest danger is the client handling chemicals without a barrier protection such as gloves. The other issues may also be dangers depending on the chemicals and the environment in which the client is working and should also be evaluated.

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem?

12.0 cm Explanation: The diagonal conjugate, usually 12.5 cm or greater, indicates 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.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention?

24 cm Explanation: An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect?

28 cm Explanation: Fundal height should be approximately equal to the number of weeks' gestation. In this case, it would be 28 cm.

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is:

December 30 Explanation: Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?

G3 T0 P1 A1 L2 Explanation: G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.

A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her?

Health-seeking behaviors related to ways to relieve discomforts of pregnancy Explanation: Health-seeking behaviors is a diagnosis used to describe clients who are actively interested in learning ways to improve their health.

The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse?

Helps the lungs remain expanded after the initiation of breathing Explanation: Surfactant keeps the alveolar surfaces from sticking together, allowing the lungs to expand and making it easier for the neonate to breathe. Surfactant does not remove mucus or mature the upper airway. It does not effect the breathing pattern, just the effort needed to expand the alveoli.

The nurse is documenting subjective and objective data changes from a client at 34 weeks' gestation. Which would the nurse report immediately to the health care provider? Select all that apply.

Scant spotting on underwear Sharp abdominal pain The nurse is correct to report to the health care provider any signs of vaginal bleeding and sharp abdominal pain as these could indicate an emergency. Normal common discomforts of pregnancy include difficulty sleeping due to the increased size of the abdomen, feeling faint due to postural hypotension, bleeding gums and nosebleeds due to hormonal and drying effects of pregnancy. While it is common to have sharp round ligament pain from the increasing pregnancy, it is usually on the right side and must be further examined.

The nurse is caring for a client who is at 37 weeks' gestation and has a biophysical profile of 10. Which nursing action is best?

Schedule a health care provider appointment for one week. Explanation: A biophysical profile of 10 is a good score indicating fetal well-being. The nurse would schedule this client for her weekly health care provider appointment. There is no need to immediately notify the health care provider, have the client report to the hospital nor prepare the records for a cesarean birth indicating the fetus needs to be born.

The health care provider has prescribed an over-the-counter antacid for a pregnant client in her first trimester who is having ongoing nausea, vomiting, and heartburn. Which instruction concerning the antacid should the nurse prioritize after noting the client is also prescribed a multivitamin supplement?

Take antacid 1 hour after the multivitamin. Explanation: Antacids interfere with the uptake of the vitamin contents so the client should take the antacid 1 hour after taking the multivitamin. Caffeine should be avoided due to increases in blood pressure and diuretic effects. Antacids can be taken more often than solely at bedtime, and some clients need them after each meal. Antacids do not have to be taken with dairy products. The priority is to avoid allowing the antacid to cancel out the multivitamin.

A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?

Use extra pillows. Explanation: The nurse should instruct the client to use extra pillows at night to keep her more upright. The nurse can instruct the client to use a firmer mattress if the client is experiencing backache. The nurse can ask the client to avoid overeating and ingesting spicy food in case the client is experiencing heartburn.

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.

headache with visual changes in the third trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester Explanation: Danger signs and symptoms that need to be reported immediately include headache with visual changes in the third trimester; 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.

The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition?

nausea and vomiting Explanation: Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.

The nurse performs a nonstress test (NST) on a client at 36 weeks' gestation. What criteria on the tracing does the nurse use to determine that the NST is reactive?

presence of 2 accelerations in 20 minutes Explanation: A nonstress test (NST) is an assessment of fetal well-being. The criteria for a reactive NST is the presence of two accelerations within 20 minutes. The presence of decelerations or contractions would require further evaluation of fetal status.

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question?

rubella Explanation: Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best?

"At 36 weeks' gestation, the fundus is in the normal expected location." Explanation: The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.

A community health nurse completes the home visit. The client is 2 weeks postpartum and is breastfeeding. The nurse asks the client if they have any breastfeeding questions. Drag words from the choices below to fill in each blank in the following sentence. The client statements that require additional teaching are "Breastfeeding and formula feedings offer the same benefits.", "I may supplement my breast milk with formula when I am not home.", and "I may use a pacifier while breastfeeding when the infant becomes fussy"

"Breastfeeding and formula feedings offer the same benefits.", "I may supplement my breast milk with formula when I am not home.", and "I may use a pacifier while breastfeeding when the infant becomes fussy" A breastfeeding client should not give an infant anything other than breast milk if possible. Many breastfeeding clients pump milk for supplemental feedings. Breastfeeding offers more benefits than formula feeding for the infant, such as antibodies that may help prevent the incidence of disorders such as asthma, cancers, and diabetes later in life. Breastfeeding also provides benefits to the client such as reducing the risk of certain cancers including breast and ovarian cancer as well as chronic disorders such as rheumatoid arthritis and lupus. A pacifier should not be used while breastfeeding because this may cause nipple confusion in the infant. The infant should be placed in a "sniffing" position when breastfeeding. This statement does not require clarification. "I should breastfeed every 2 to 3 hours even if the infant is sleeping" is a correct statement. New parents, however, sometimes do not want to wake the infant for a feeding.

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." Explanation: Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.

The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement?

"Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them." Explanation: The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

A pregnant client reports frequent urination and tells the health care provider that she has stopped drinking water during the day since she cannot take many breaks during work. Which statement by the nurse is most appropriate at this time?

"Fluids are necessary so your blood volume can double, which is normal in pregnancy." Women should not restrict their fluid intake to diminish frequency of urination because fluids are necessary to allow blood volume to double. Decreasing daily caffeine intake because of the risks caffeine poses for low birth weight may have the added benefit of reducing urinary frequency. Most importantly, a woman needs to understand that voiding more frequently is a normal pregnancy finding. The sensation of frequency will probably return after lightening (the settling of the fetal head into the inlet of the pelvis at pregnancy's end). A note for the supervisor is inappropriate in the workplace.

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern?

"I am unsure who the father of the baby is. I will be raising it alone." Explanation: While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing Rho(D) immune globulin, and having social issues does not place the client at risk for sexually transmitted infections.

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement?

"I should lie down for 1/2 hour after eating." Explanation: 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 pyrosis (heartburn) of pregnancy.

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching?

"I should substitute intercourse with nonsexual touch to avoid harming the fetus." Explanation: Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." Explanation: 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 over-the-counter medications for both pregnancy-related conditions and 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 over-the-counter medications and herbal agents. Many women consider these products benign 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 woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every:

4 weeks. Explanation: 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.

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.

4, 1, 1, 1, 1 Explanation: The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.

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?

6.5% Explanation: A hemoglobin A1C level of at least 6.5% is concerning for overt diabetes, and further testing should be conducted to ensure the client does not have diabetes. If glucose testing is not diagnostic of overt diabetes, the woman should be tested for gestational diabetes from 24 to 28 weeks' gestation with a 75-gm oral glucose tolerance test.

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which instruction should the nurse provide to promote easy and safe travel for the client?

Always wear a three-point seat belt. Explanation: To promote easy and safe travel for the client, the nurse should instruct the client to always wear a three-point seat belt to prevent ejection or serious injury from collision. The nurse should instruct the client to deactivate the air bag if possible. The nurse should instruct the client to apply a nonpadded shoulder strap properly, ensuring that it crosses between the breasts and over the upper abdomen, above the uterus. The nurse should instruct the client to use a lap belt that crosses over the pelvis below—not over—the uterus.

What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy?

Ask her to describe her intake for the last 24 hours. Explanation: A 24-hour food intake history is the best method to assess food intake in all individuals.

At the first prenatal visit, the client reports her last menstrual period (LMP) was November 16. The nurse determines the estimated due date to be:

August 23 Explanation: There are several methods to determine the estimated date of birth. Naegele 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 November 16 subtract 3 months (August), add 7 days (23), and adjust the year by adding 1 year. This client's estimated date of birth is August 23, in the following year.

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?

Avoid medications. Explanation: The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).

A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise?

Come to the hospital now for assessment. Explanation: Generally, clients are advised to come to the hospital once contractions are 5 minutes apart, but because this client has a history of fast (4 hour) labor and lives 45 minutes away from the hospital, the client should be advised to come to the hospital now. Membranes may rupture at any point in labor and should not dictate the timing of hospital admission. Bloody show is a normal finding in labor, but it does not determine the stage of labor or when the client should come to the hospital.

A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?

Conduct an interview in a private room to obtain her health history. Explanation: Health interviewing is always conducted best in a quiet, private setting before examination procedures begin.

At 34 weeks' gestation a client is diagnosed with preeclampsia and sent home on bed rest. The nurse teaches the client to contact the provider immediately if she experiences which change?

Decreased fetal movement Explanation: Decreased fetal movement may indicate decreased fetal oxygenation as a result of hypertension. This is a risk to fetal well-being and the provider needs to be contacted. Decreased weight and increased urine output are signs that the body is mobilizing excessive fluid, and are normal findings. Change in appetite is unrelated to preeclampsia.

A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this?

Delay breakfast until mid-morning. Explanation: The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

The health care provider is concerned about a client's fetus having appropriate blood flow through the fetal vessels. Which diagnostic test does the nurse anticipate to confirm a diagnosis?

Doppler study Explanation: The Doppler flow study is best for identification of blood flow. It places a transducer on the client's abdomen and allows the sonographer to assess blood flow through fetal vessels and in the fetal aorta, brain and heart. A transabdominal ultrasound is commonly used to determine gestational age, observe the fetus and diagnose complications of pregnancy. Amniocentesis is commonly used to identify chromosomal or genetic abnormalities. The maternal serum alpha-fetoprotein screening is used to determine neural tube defects.

A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend?

Eat fiber-rich foods. Explanation: Increasing dietary fiber is the best way to address constipation. Laxatives, suppositories, and enemas only provide temporary relief and may stimulate labor.

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?

Further testing will be required to confirm any diagnosis. Explanation: 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.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:

G = 3, T = 1, P = 0, A = 1, L = 1 Explanation: The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day?

July 16 Explanation: According to Naegele rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.

A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises?

Maintain tolerable intensity of exercise. Explanation: Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.

During a postpartum hemorrhage, the nurse anticipated administering which medication to cause vasoconstriction of the uterine vessels?

Methylergonovine Explanation: Oxytocin, methylergonovine and misoprostol all stimulate the uterine muscle to contract. Methylergonovine is the only medication that also stimulates vasoconstriction of the uterine vessels, thereby decreasing bleeding. Fentanyl is a pain medication. Magnesium sulfate is a smooth muscle relaxant.

The nurse is conducting an assessment of a pregnant client at a routine second trimester prenatal visit. Which lower extremity assessment should the nurse prioritize?

Presence of varicosities Explanation: During pregnancy, women are prone to develop varicosities because of uterine pressure on lower-extremity veins. Evaluating the diameter of the calf would be important if a deep vein thrombosis was suspected. Capillary refill of the toenails would be a routine evaluation. Lateral movement of the kneecap would not be a priority.

The nurse is reviewing an employer's guidelines to support pregnant employees. When reviewing the information, which guideline requires further follow-up and education by the nurse?

Promote overtime shifts to save money for parental leave. Explanation: Excessive overtime and working longer than 8-hour shifts are associated with an increase in preterm labor and other pregnancy complications; this is not recommended. Providing an area for rest supports the need for additional rest by pregnant employees. Support hose help to promote venous return and are useful for employees who spend a lot of time standing. Modifying duties during later pregnancy is important, as balance may be compromised and strenuous activity is not recommended.

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?

Serve the formula at room temperature. Explanation: The nurse should instruct the client to serve the formula to her infant at room temperature. The nurse should instruct the client to follow the directions on the package when mixing the powder because different formulas may have different instructions. The infant should be fed every 3 to 4 hours, not every 8 hours. The nurse should specifically instruct the client to avoid refrigerating the formula for subsequent feedings. Any leftover formula should be discarded.

A woman has heard that hypotension can be a problem during pregnancy, but she is not sure what it is or what causes it. The nurse explains that it is simply a temporary bout of low blood pressure due to impaired blood return to the heart. It is commonly caused by sleeping in a position that causes compression of the vena cava blood vessel. To avoid this condition, which suggestion should the nurse make?

Sleep on your side. Explanation: Supine hypotension is a symptom that occurs when a woman lies on her back and the uterus presses on the vena cava, impairing blood return to her heart. A woman experiences an irregular heart rate and a feeling of apprehension. To relieve the problem is simple: if a woman turns or is turned onto her side, pressure is removed from the vena cava, blood flow is restored, and the symptoms quickly fade. To prevent the syndrome, advise pregnant women to always rest or sleep on their side, not their back. Sleeping face down is not advised, and sleeping with the feet elevated would not prevent compression of the vena cava.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage?

Stretching and breathing exercises such as yoga Explanation: It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.

The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective?

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. Explanation: A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

When describing the role of a doula to a group of pregnant women, the nurse would include which information?

The doula primarily focuses on providing continuous labor support. Explanation: 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.

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steroids. What is the best explanation by the nurse?

The steroids speed up the development of the lungs. Explanation: Steroids given to the mother before birth help to speed up the development of the fetal lungs. The use of prenatal steroids has decreased the mortality rate in preterm infants. Prenatal steroids do not increase muscle mass or amount of fat tissue to aid in temperature regulation. Prenatal steroids do not have an impact on the development of sepsis in either the mother or neonate.

A client at 34 weeks' gestation reports difficulty sleeping at night. What will the nurse recommend?

Try relaxation exercises at bedtime. Explanation: Relaxation or mindfulness exercises may help with falling asleep. Large meals may increase heartburn in late pregnancy, which can interfere with sleep due to discomfort; therefore, large meals are not recommended. Napping or an afternoon rest period may be required to ensure adequate rest and sleep. An over-the-counter sleep aid should not be recommended without further consultation.

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client?

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. Explanation: Daily tub baths or showers are recommended. Women should not soak for long periods in extremely hot water or hot tubs, however, as heat exposure for a lengthy time could lead to hyperthermia in the fetus and birth defects, specifically esophageal atresia, omphalocele, and gastroschisis. As pregnancy advances, a woman may have difficulty maintaining her balance when getting in and out of a bathtub. If so, she should change to showering or sponge bathing for her own safety. If membranes rupture or vaginal bleeding is present, tub baths become contraindicated because there might be a danger of contamination of uterine contents. Soap is not a teratogen to the fetus.

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?

Wear support hose. Explanation: The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight.

The nurse discovers a new prescription for Rho(D) immune globulin for a client who is about to undergo a diagnostic procedure. The nurse will administer the Rho(D) immune globulin after which procedure?

amniocentesis Explanation: Amniocentesis is an invasive procedure whereby a needle is inserted into the amniotic sac to obtain a small amount of fluid. This places the pregnancy at risk for a woman with Rh(D)-negative blood, since the puncture can allow the seepage of blood and amniotic fluid into the woman's system. She should receive Rho(D) immune globulin after the procedure to protect her and future babies. The CST, NST, and a biophysical profile are noninvasive tests.

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function?

amniotic fluid volume Explanation: A biophysical profile combines five parameters (fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic fluid volume) into one assessment. The fetal heart and breathing record measures short-term central nervous system function; the amniotic fluid volume helps measure long-term adequacy of placental function.

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?

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

Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing?

clean-catch urine Explanation: The first procedure a nurse should ask the client to do is obtain a clean-catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or have an ultrasound performed.

While assessing a client's breast during the third trimester, which finding would the nurse expect?

colostrum from the nipples Explanation: During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor?

contractions beginning in the back and sweeping forward across the abdomen Explanation: True labor contractions usually begin in the back and sweep forward across the abdomen similar to tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. Lightening and intermittent backache are preliminary signs of labor but do not indicate true labor. Increase in fetal kick count does not indicate true labor.

A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client?

dark, leafy green vegetables Explanation: Dark leafy green vegetables are a source of calcium. Red and orange vegetables contain a variety of vitamins, bread and rice contain carbohydrates, and meat and fish contain protein, but none of these foods are a good source of calcium.

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including:

decreased birth weight in neonates. Explanation: The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.

A pregnant client has completed a 24-hour dietary recall (above). Which food(s) on the client's recall form will help to prevent anemia in pregnancy? Select all that apply.

enriched whole wheat bread omelet with spinach and cheddar cheese beef patty Dietary iron in pregnancy will help to prevent anemia. Enriched bread, eggs and spinach, and beef are all good sources of dietary iron. Hummus and peanut butter are not significant sources of dietary iron.

Which finding from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a primary care provider for management?

episodes of double vision Explanation: Difficulty with vision can occur from cerebral edema or is a symptom of hypertension of pregnancy.

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy?

excessive vomiting Explanation: Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.

A nurse in a prenatal clinic is caring for a 26-year-old client in the second trimester who has come to the clinic for a scheduled checkup. The nurse performs a focused assessment and discusses unexpected signs and symptoms during the second trimester that, if experienced, will require prompt treatment. The client is at risk for developing BLANK, BLANK, BLANK, BLANK, for which the client should report if experienced.

hyperemesis, dsyuria, diarrhea, sudden SOB Explanation: Anticipatory guidance should be provided at each prenatal visit to ensure the client understands what to expect (normal signs and symptoms) during each trimester and what signs and symptoms are unexpected and require follow-up. Dysuria is an unexpected symptom during the second trimester of pregnancy and requires immediate follow-up. Painful urination may indicate an infection, which may cause premature labor. Hyperemesis is an unexpected symptom during the second trimester of pregnancy and requires immediate follow-up. Hyperemesis may cause dehydration. Diarrhea is an unexpected symptom during the second trimester of pregnancy and requires immediate follow-up. Diarrhea may indicate an infection, which may cause premature labor. Diarrhea may also cause dehydration. Although shortness of breath is an expected symptom during the second trimester due to the growing fetus pushing the diaphragm upward preventing full expansion of the lungs, sudden shortness of breath is an unexpected symptom that may indicate pulmonary embolism, which is a life-threatening medical condition if left untreated. Urinary frequency is an expected symptom during the second trimester of pregnancy. Constipation is an expected symptom during the second trimester of pregnancy. Heartburn is an expected symptom during the second trimester of pregnancy. Nausea and vomiting are expected signs and symptoms during the second trimester of pregnancy.

An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question?

intimate partner violence Explanation: Pregnant women, especially adolescents, are at increased risk for intimate partner violence. The nurse needs to ask enough questions to be certain that the woman is not experiencing physical, sexual, or emotional intimate partnership violence.

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?

live virus vaccine Explanation: 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 pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client?

on her side with the weight of the uterus on the bed Explanation: Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care?

once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth Explanation: The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

Click to highlight the findings that will require follow-up. A nurse is caring for a 20-year-old primigravida client who is at 18 weeks' gestation. The client had been experiencing occasional nausea and vomiting in the morning and now reports persistent nausea and vomiting in the past 48 hours. Client has lost 3 lb (1.36 kg) in 2 days. The nurse performs a comprehensive assessment on the client. Vital signs: heart rate, 110 beats/minblood pressure, 88/56 mm Hg. Laboratory values: blood urea nitrogen (BUN), 25 mg/dl (8.93 mmol/l) and sodium 148 mEq/l (148 mmol/l).

persistent nausea and vomiting in the past 48 hours. lost 3 lb (1.36 kg) in 2 days heart rate, 110 beats/minblood pressure, 88/56 mm Hg blood urea nitrogen (BUN), 25 mg/dl (8.93 mmol/l) sodium 148 mEq/l (148 mmol/l) Explanation: Hyperemesis gravidarum usually occurs during the first trimester of pregnancy due to high human chorionic gonadotropin (hCG) levels. Hyperemesis gravidarum is persistent nausea and vomiting with weight loss due to inability to ingest food or fluid, which leads to dehydration. A 3-lb (1.36-kg) weight loss in 2 days due to persistent nausea and vomiting is an indication the client is experiencing hyperemesis gravidarum. The weight loss is due to the client's inability to ingest food or fluids, which leads to severe dehydration and malnutrition. The nurse should request intravenous fluids. A blood urea nitrogen (BUN) level of 25 mg/dl (8.9 mmol/l) (normal: 8 to 20 mg/dl; 2.9 to 7.5 mmol/l) is an indication that the client is dehydrated.A serum sodium level of 148 mEq/l (148 mmol/l) (normal: 135 to 145 mEq/l; 135 to 145 mmol/l) is an indication that the client is dehydrated. A blood pressure of 88/56 mm Hg may be an indication of dehydration. A heart rate of 110 beats/min is a compensatory mechanism due to the low blood pressure. Nausea and vomiting in the morning is common in the first trimester. Hyperemesis gravidarum is persistent nausea and vomiting, with weight loss due to the inability to tolerate food or fluids.

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy?

potential for greater than usual back pain Explanation: Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

During the initial obstetrical clinic visit, the nurse shares with a client that several blood studies will be drawn. What screening is performed for Black women because of the ethnically inherited nature of the disease?

sickle-cell trait or disease Explanation: A genetic screen is common for ethnically inherited diseases. Black women, for example, may have a blood sample taken to screen for sickle-cell trait or disease. Asian and Mediterranean women may be screened for beta-thalassemia, those with Jewish ancestry may be screened for Tay-Sachs disease, and White women may be tested to see if they are a carrier for cystic fibrosis.

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy?

soft systolic murmur Explanation: A soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.

The nurse educates the vegetarian client about which nutritional need during pregnancy?

taking a B12 supplement Explanation: B12 is found almost exclusively in animal proteins and therefore is absent in the vegetarian diet. Fiber and dark green vegetables are needed. Vitamins A and C are not protein based and are found in a vegetarian diet.

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is:

the first day of the last menstrual period. Explanation: Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.

Why is the first prenatal visit usually the longest prenatal visit?

Baseline data is collected. Explanation: The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready?

ultrasound equipment Explanation: First, the health care provider identifies a pocket of amniotic fluid using an ultrasound machine. A scalpel is not used in the procedure. A urine culture is not obtained prior to the procedure nor is a Foley catheter inserted.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider?

vaginal bleeding Explanation: In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.