Chapter 7: Prenatal Care
The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate?
"Do you have a cat in the house?" Explanation: Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities
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."
The nurse manager of a prenatal clinic has implemented interventions to individualize the prenatal care experience. Which client statement indicates that the nurse's efforts have been successful?
"It was so nice to not have to wait long in the waiting room." Explanation: Strategies to individualize prenatal care include trying to schedule appointments so there won't be a long wait time, providing privacy for weight and blood pressure assessments, educating on care options and encouraging participating in decisions about care, and providing materials on pregnancy in the waiting room.
The nurse teaches a pregnant client the manifestations associated with complications while pregnant. Which statement indicates that additional client teaching is needed?
"Pain with urination is expected during pregnancy." Explanation: Pain on urination is a symptom of a urinary infection, potentially serious because these are associated with preterm birth. This statement indicates that additional client teaching is needed. The client should call the doctor with any vaginal bleeding. A sudden rush of fluid indicates the membranes have ruptured. Once a day vomiting is not uncommon during the first trimester of pregnancy.
A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction?
"Taking gentle enemas no more frequently than once a week is acceptable
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 gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate?
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." Explanation: Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.
A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate
"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." Explanation: Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.
During the interview portion of her first prenatal visit, a woman reports she thinks she may have a vaginal infection. When questioned, she reports the discharge is thick, greenish-yellow, and she is very uncomfortable. She reports she thinks it is "yeast." How should the nurse reply
"Yeast is usually a thick, cheesy, white discharge so we will need to evaluate it during the pelvic exam." Explanation: Yeast is normally a thick, cheesy discharge. Greenish-yellow discharge is associated with gonorrhea.
The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy?
20 cm Explanation: Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy
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.
How should the nurse document a pregnant client's gestational status using the GTPAL system after collecting the following data? Currently 18 weeks pregnantClient's fourth pregnancyDelivered one nonviable fetus at 26 weeksExperienced one miscarriageDelivered one viable fetus at 38 weeks' gestation
4, 1, 1, 1, 1 Explanation: GTPAL is a more comprehensive system for classifying pregnancy status. By this system, the gravida classification remains the same, but para is broken down into T: the number of full-term infants born (infants born at 37 weeks or after), P: the number of preterm infants born (infants born before 37 weeks), A: the number of spontaneous miscarriages or therapeutic abortions, and L: the number of living children. The client has been pregnant four times. The client delivered one viable infant at 38 weeks. The client delivered one nonviable fetus at 26 weeks. The client had one miscarriage. The client has one living child.
The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?
Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling
The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?
Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Explanation: While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.
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.
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.
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 multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020 Explanation: Gravida (G) is the total number of pregnancies she has had, including the present one. Therefore she is G3 and not G2. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today. She has no living children; therefore, it is 0 and not 1.
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1 Explanation: The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.
The nurse is caring for a neonate whose mother received no medical care for either of her pregnancies. When assessing the neonate's status, which would indicate a potential A, B, and O incompatibility?
Hemolytic anemia Explanation: Antibody screens are done to recognize women who may be at risk of developing antigen incompatibilities with fetal red blood cells. If the incompatibility develops, and is not addressed quickly, the neonate may develop hemolytic anemia as the mother's antibodies cross the placenta and attack the fetus's red blood cells. Hypothyroidism can affect the fetus's nervous system. Dehydration may lead to electrolyte deficiencies. Abnormal bleeding is less common due to the initiation of Vitamin K.
Why is a Papanicolaou test done at the first prenatal visit?
It identifies abnormal cervical cells. Explanation: A Pap test is a test for cervical cancer. Should abnormal cells be present, the woman may need to make a decision about her priorities of therapy for cervical disease or continuing the pregnancy.
When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one?
Provide knowledge and skills to actively participate in birth and parenting. Explanation: The primary focus of perinatal education is to provide information and support to clients and their families to foster a more active role in the upcoming birth. It also includes preparation for breastfeeding, infant care, transition to new parenting roles, relationships skills, family health promotion, and sexuality. Some methods of birth education focus on pain-free birth. Information provided in birth education classes helps to minimize anxiety and provide the couple with control over the situation, but elimination of anxiety or total control is unrealistic
A nurse working in a correctional facility is monitoring a group of pregnant inmates. Which interventions might be necessary to improve the health of these incarcerated pregnant women? Select all that apply.
Provide prenatal vitamins Ensure frequent hydration Recommend activity restrictions Coordination of care with off-site providers Provide extra food and exclude unpasteurized items
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 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.
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.
A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy?
amniocentesis Explanation: Amniocentesis to screen for congenital anomalies can be done starting at 14 weeks' gestation. This procedure carries risks of spontaneous abortion (miscarriage), infection, and placental abruption. Cardiocentesis is used less commonly to determine blood disorders. Chorionic villus sampling is performed at 8 to 12 weeks' gestation. Nuchal translucency testing is done between 11 and 13 weeks' gestation.
During pregnancy, the cardinal rule concerning medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy?
asthma Explanation: Treatment (including medications) for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression.
The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation?
at the level of the umbilicus Explanation: By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum.
A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?
at the level of the umbilicus Explanation: In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.
While conducting the first prenatal health history visit, the nurse learns that a pregnant client is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the client at this time?
deficient knowledge regarding exposure to teratogens during pregnancy Explanation: The client is taking herbal remedies and over-the-counter medications, many of which can be teratogenic to the developing fetus. This is the most appropriate nursing diagnosis for the nurse to select for this assessment finding. There is not enough information to determine if the fetus is at risk because of the client's lifestyle choices. The client has not asked for specific information so health-seeking behavior diagnoses would not be appropriate for the client at this time.
A primapara woman, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic today for further assessment?
feeling of achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour Explanation: A woman should report vaginal bleeding, no matter how slight, because some of the serious bleeding complications of pregnancy begin with only slight spotting. Constipation followed by hemorrhoid development is common with pregnancy. Walking up stairs during the third trimester does produce some shortness of breath. It is normal to have some colostrum, or pre-milk, discharge during pregnancy.
A pregnant client tells the nurse, "My health care provider told me that I have the best type of pelvic shape to deliver my baby vaginally." The nurse interprets this statement as indicating that the client has which pelvic shape?
gynecoid Explanation: A gynecoid, or "female," pelvis has an inlet that is well rounded forward and backward and has a wide pubic arch. This pelvic type is ideal for childbirth. In an android, or "male," pelvis, the pubic arch forms an acute angle, making the lower dimensions of the pelvis extremely narrow. A fetus may have difficulty exiting from this type of pelvis. In an anthropoid, or "ape-like," pelvis, the transverse diameter is narrow; the anteroposterior diameter of the inlet is larger than usual. Even though the inlet is large, the shape of the pelvis does not accommodate a fetal head as well as a gynecoid pelvis. A platypelloid, or "flattened," pelvis has a smoothly curved oval inlet, but the anteroposterior diameter is shallow. A fetal head might not be able to rotate to match the curves of the pelvic cavity.
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.
During the initial prenatal visit, a client indicates that she frequently experiences stress incontinence. Which of the following should the nurse recommend to the client to help relieve this condition?
perform Kegel exercises Explanation: As part of any woman's gynecologic history, assess for the possibility of stress incontinence (incontinence of urine on laughing, coughing, deep inspiration, jogging, or running). Women can relieve stress incontinence to some degree by strengthening perineal muscles with the use of Kegel exercises. Perineal self-examination is inspecting the external genitalia monthly for signs of infection or lesions. Reduction of fluid intake should not be encouraged, as this could lead to dehydration. Increasing intake of water would not relieve stress incontinence, but rather would more likely make it worse, due to the bladder being even more distended with the increased volume of fluid.
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.
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.
