chapters 11 12

Which possible complication associated with back pain can lead to premature contractions? increased intracranial pressure bladder or kidney infection herniated disc leak of spinal fluid into the epidural space

bladder or kidney infection Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. Increased ICP, spinal fluid leak, and a herniated disc are usually not associated with back pain during a normal pregnancy.

The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? nosebleeds blood clots heartburn constipation

heartburn Filling the stomach with heavy food and fluid can cause overfill and place pressure on the stomach, increasing gastric reflux. Avoid excess fluids with meals and eat small frequent meals to avoid heartburn. Nosebleeds result from increased estrogen. Blood clots can result from sitting still for too long. Constipation can result from increased progesterone.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? lightening linea nigra placenta previa quickening

quickening The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? Dyspnea Ptyalism Kyphosis Increased hematocrit

Dyspnea In the third trimester, a women experiences dyspnea from the uterus pushing up into the diaphragm. A pregnant woman will experience lordosis, not kyphosis. Ptyalism is excessive saliva production and is often seen in the first trimester of pregnancy. The hematocrit of a pregnant woman will decrease in the third trimester, not increase.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Eat dry crackers or toast before rising. Avoid eating spicy food. Avoid foods such as cheese. Drink plenty of fluids at bedtime.

Eat dry crackers or toast before rising. The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 18 cm 30 cm 32 cm 24 cm

24 cm 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.

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. 2 weeks. 1 week. 3 weeks.

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 client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign? Goodell sign Hegar sign Chadwick sign Braxton sign

Chadwick sign Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy? Chadwick sign fetal movement felt by examiner Hegar sign positive office pregnancy test

fetal movement felt by examiner The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

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? the importance of healthy lifestyle family history of pregnancy complications importance of taking adequate vitamin and mineral supplements the use of OTC drugs with teratogens

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 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? severe, persistent vomiting painful urination lower abdominal and shoulder pain vaginal bleeding

vaginal bleeding 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.

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 fill in , fill i nand fill in . Client Statements "I may use a pacifier while breastfeeding when the infant becomes fussy." "I may supplement my breast milk with formula when I am not home."" Breastfeeding and formula feedings offer the same benefits." "My infant should be placed in a 'sniffing' position when breastfeeding." "I should breastfeed every 2 to 3 hours even if the infant is sleeping."

"I may supplement my breast milk with formula when I am not home." "I may use a pacifier while breastfeeding when the infant becomes fussy." Breastfeeding and formula feedings offer the same benefits." 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.

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective? "I will need to take iron supplementation throughout my pregnancy even if I am not anemic." "I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." "Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." "Because I am pregnant, I can eat anything I want and not worry about weight gain."

"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recommendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby.

A client makes an appointment with an obstetrician and assessment reveals positive Hegar and Chadwick signs. What should the nurse teach the client about these results? She is probably pregnant, but this must be confirmed by other means The client is definitively pregnant Pregnancy cannot be confirmed The client more likely has a gynecologic disorder rather than pregnancy

She is probably pregnant, but this must be confirmed by other means These are probable signs of pregnancy that can be detected by a trained examiner. However, positive signs must confirm this.

A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual? Venous congestion in the pelvis makes orgasm painful. Most women do not experience orgasm during pregnancy. Orgasm during pregnancy is potentially harmful. Some women experience orgasm intensely during pregnancy.

Some women experience orgasm intensely during pregnancy. Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? Deeply fissured nipples Darkened breast areolae Enlarged lymph nodes Slack, soft breast tissue

Darkened breast areolae As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next? Tell the woman that this is entirely normal. Ask the woman if she is having any itching or irritation. Check the discharge for evidence of ruptured membranes. Advise the woman about the need to culture the discharge.

Ask the woman if she is having any itching or irritation. Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

Which change related to the vital signs is expected in pregnant women? Lung space increases. Temperature decreases. Pulse decreases. Blood pressure decreases.

Blood pressure decreases. Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.

A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? Eat fiber-rich foods. Use a water-based enema. Take a fiber-based laxative. Insert a glycerin suppository.

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

During a physical exam, the physician notates that the pregnant client has a positive Chadwick sign. What client findings would be noted for this symptom? There is hyperpigmentation of the abdomen. The cervix has a bluish, purple discoloration. The cervix is reddened and swollen. There is a rebound of the fetus felt when the physician pushes on the abdomen.

The cervix has a bluish, purple discoloration. Probable signs of pregnancy include several objective physical changes in the mother. One of them is the Chadwick sign, which is seen during the pelvic exam of the client and involves a bluish, purplish discoloration of the vulva, vagina and cervix.

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 will create a layer of fat to help with temperature regulation. The steroids speed up the development of the lungs. The steroids will increase the baby's muscle mass. The steroids will help to slow the development of infection.

The steroids speed up the development of the lungs. 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? Avoid napping to improve quality of nighttime sleep. Eat a large evening meal to prevent hunger during the night. Use an over-the-counter sleep aid. Try relaxation exercises at bedtime.

Try relaxation exercises at bedtime. 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.

When developing a plan of care, the nurse needs to make which assessments for a pregnant client with a BMI of 18.3? Select all that apply. assess for maternal fatigue assess for poor fetal growth assess for gestational diabetes assess for eclampsia assess for preterm labor

assess for maternal fatigue assess for poor fetal growth assess for preterm labor With a low prepregnancy BMI of 18.3, this client needs to be monitored for complications related to deficient nutrient stores such as fatigue, poor fetal growth, and preterm labor. A low BMI does not place this client at high risk for gestational diabetes or eclampsia.

While assessing a client's breast during the third trimester, which finding would the nurse expect? pain in the nipple area pink-colored nipples colostrum from the nipples breasts becoming soft

colostrum from the nipples 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.

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 swelling of extremities dyspnea lower abdominal pressure

excessive vomiting 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 pregnant client arrives at the maternity clinic reporting constipation. Which factors could be the cause of constipation during pregnancy? Select all that apply. decreased activity level increase in estrogen levels intestinal displacement use of iron supplements reduced stomach acidity

intestinal displacement use of iron supplements decreased activity level Constipation during pregnancy is due to changes in the gastrointestinal system. Constipation can result from decreased activity level, use of iron supplements, intestinal displacement secondary to a growing uterus, slow transition time of food throughout the GI tract, a low-fiber diet, and reduced fluid intake. Increase in progesterone, not estrogen levels, causes constipation during pregnancy. Reduced stomach acidity does not cause constipation. Morning sickness has been linked to stomach acidity.

To prevent exposure to hepatitis A virus, the nurse teaches the pregnant client to avoid which food? raw eggs grilled tuna undercooked chicken raw fish

raw fish The hepatitis A virus is found in raw fish. Raw eggs and undercooked chicken can transmit salmonella, and swordfish can contain high levels of mercury.

A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation? 28 weeks 32 weeks 20 weeks 24 weeks

24 weeks Fundal height is an approximation of the number of weeks of gestation. Between 20 to 32 weeks, SFH = gestation in weeks + or - 2 cm.

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant? 18 20 22 24

24 By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy. Therefore for this client, the additional 4 cm would be the equivalent of 4 additional weeks making the gestational age of 24 weeks.

A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy? 11 to 20 lbs (5 to 9 kg) 28 to 40 lbs (13 to 18 kg) 25 to 35 lbs (11 to 16 kg) 15 to 25 lbs (7 to 11 kg)

25 to 35 lbs (11 to 16 kg) A woman with a BMI of 18.5 to 24.9 is of normal weight and should gain 25 to 35 pounds (11 to 16 kg) during the pregnancy. For a woman who is underweight (BMI <18.5), the total weight gain range is 28 to 40 pounds (13 to 18 kg). For a woman who is overweight (BMI = 25-29.9), total weight gain range should be 15 to 25 pounds (7 to 11 kg). For a woman who is obese (BMI = 30 or higher), the total weight gain range should be 11 to 20 pounds (5 to 9 kg).

A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily? 27 mg 10 mg 40 mg 20 mg

27 mg The dietary reference intakes as per the Institute of Medicine are for 27 mg of ferrous iron and 400 to 800 mcg of folic acid per day. Women with a previous history of a fetus with a neural tube defect are often prescribed a higher dose.

The nurse is scheduled to see four clients. Which client is at highest risk for depression? A 17-year-old at 32 weeks' gestation, living with a 22-year-old man who is not the father of her baby, because her parents made her move out when she got pregnant A married 28-year-old at 20 weeks' gestation, with a job at the local university, health insurance and the "perfect life." A single 17-year-old at 20 weeks' gestation whose parents are supportive of her and her partner and excited about their first grandchild A single 30-year-old newly pregnant woman in a committed and supportive relationship with her high-school sweetheart. While not married, they have been living together and planning a pregnancy for the past year.

A 17-year-old at 32 weeks' gestation, living with a 22-year-old man who is not the father of her baby, because her parents made her move out when she got pregnant Risk factors for depression are young age, lack of social support, and unintended pregnancy. A young client with the support of her partner and her parents is at less risk. Similarly, women in their 20's with resources such as a job and health insurance, a planned pregnancy as well as support of their partner and family are also at lower risk for depression.

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 = 4, T = 2, P = 0, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1

G = 3, T = 1, P = 0, A = 1, L = 1 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.

What effect does progesterone have on normal gallbladder function? It has no effect on the gallbladder. Bile will be produced at a more rapid rate due to the progesterone. The gallbladder will hypertrophy. Progesterone interferes with gallbladder contraction, leading to stasis of bile.

Progesterone interferes with gallbladder contraction, leading to stasis of bile. Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gallbladder or the liver.

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? She may have a bleeding disorder so she needs to come back to the clinic for blood work. The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. It is possible she is losing her mucus plug, which can cause bloody show. Some bleeding during pregnancy is not uncommon and this finding is expected.

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

A nurse is documenting the obstetric history for a pregnant woman who has previously given birth to two infants at term and had one abortion at 12 weeks' gestation. How would the nurse document this information? gravida 4, para 2 gravida 3, para 3 gravida 3, para 2 gravida 4, para 3

gravida 4, para 2 Gravida refers to the total number of pregnancies (including current), para to the number of births. The abortion would be noted as an "A" if using the full "GTPAL."

The nurse is reviewing the charts of a group of clients. Which client's weight gain should the nurse be concerned about? the client who gained 15 lb (7 kg) and is in the second trimester the client who gained 25 lb (11 kg) and is in the third trimester the client who gained 4 lb (2 kg) in the first trimester the client who gained 8 lb (4 kg) in the first trimester

the client who gained 8 lb (4 kg) in the first trimester Expected weight gain is 1.5 (0.68 kg) pounds per month in the first trimester and 1 lb (0.45 kg) per week in the second and third trimesters. A weight gain of 8 lb (4 kg) in the first trimester is excessive. The other weight gains are within range for the state of pregnancy.

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "Expect your other children to react positively to their new brother/sister." "The hormones of pregnancy may cause anxiety or depression postpartum." "Your old coping methods will adequately get you through this period of adjustment." "Caring for your new infant is instinctual and will come naturally to you."

"The hormones of pregnancy may cause anxiety or depression postpartum." The "raging hormones" of pregnancy can keep the woman slightly out of touch with her usual methods of coping. Although she may normally interact and communicate in quite mature ways, during a pregnancy she may become depressed, anxious, withdrawn, or angry as she accomplishes her own developmental tasks. Siblings often react to a pregnancy by regression in behavior and attitude because they fear they will be replaced or unloved. In addition to anticipatory guidance concerning the alterations in family structure and functioning, prenatal preparation for first-time parents involves learning the basics of infant care and preparing for infant feeding, particularly for women who plan to breastfeed.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You need to be assessed for a fungal infection." "Use a local antifungal agent regularly." "You should refrain from any sexual activity." "This discharge is normal during pregnancy."

"This discharge is normal during pregnancy." During pregnancy, vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection (a monilial vaginitis), which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy? "You should switch to herbal remedies because they are safer to use than other types medicines." "You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." "It is safe for you to take over-the-counter medications." "You need to avoid all prescription, over-the-counter, and herbal medications when you are pregnant."

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal 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 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 pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby? Congenital hypothyroidism Low birth weight Neural tube defects Night blindness

Congenital hypothyroidism Iodized sodium is needed by the body for normal thyroid function. Women with severe iodine deficiencies deliver infants with congenital hypothyroidism. Low birth weight is related to smoking and alcohol. Neural tube defects are caused by low folic acid levels. When vitamin A levels are too low, night blindness may occur.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely? Fundal height has dropped since the last recording. The lower uterine segment and cervix have softened. Fundal height is at its highest level at the xiphoid process. The fundus is at the level of the umbilicus and measures 20 cm.

Fundal height has dropped since the last recording. Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes? Hegar sign Chadwick sign ballottement Goodell sign

Goodell sign The description of a Goodell sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam elicits the fetus to rise against the abdominal wall. Chadwick sign is when the vagina changes color from pink to violet. Hegar sign is softening of the lower uterine segment.

A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement? The level of aldosterone during pregnancy reduces production of IgG antibodies. The kidneys release a hormone during pregnancy to prevent this from happening. Immunologic activity is decreased during pregnancy. The decreased corticosteroid activity during pregnancy ensures this will not happen.

Immunologic activity is decreased during pregnancy. It is unproven why women do not reject fetal (foreign) tissue, but a substance secreted by the placenta is thought to decrease the usual immunologic response and prevent this from happening.

The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include? Select all that apply. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. Increase consumption of fruits, vegetables, and whole grains. Increase caloric intake. Consume at least one quart of water daily.

Increase consumption of fruits, vegetables, and whole grains. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. For a pregnant woman to meet recommended DRIs, she should eat according to the U.S. Department of Agriculture (USDA) food guide, MyPlate. Some of these guidelines include eating a variety of foods from all food groups, using portion control; increase intake of vitamins, minerals, and dietary fiber; lower intake of saturated fats, trans fats, and cholesterol; increase intake of fruits, vegetables, and whole grains; and balance calorie intake with exercise to maintain an ideal healthy weight.

A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out? Increased pulse rate and blood pressure No change in pulse rate or blood pressure Decreased pulse rate and increased blood pressure Increased pulse rate and decreased blood pressure

Increased pulse rate and decreased blood pressure Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? Place the client in an orthopneic position. Keep the head of the client's bed slightly elevated. Place the client in the left lateral position. Keep the client's legs slightly elevated.

Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

The community nurse is preparing a presentation for a health fair illustrating successful pregnancies. Which component should the nurse prioritize as the most critical to ensure a positive psychological experience with the pregnancy by the mother? Having a planned pregnancy Early prenatal care Age at the time of pregnancy Social support

Social support All options are correct and play a role pregnancy, but the most critical for a positive psychological experience is for the woman to have a social support system. Early care, maternal age, and planned pregnancy all affect fetal and maternal health, but are not necessarily linked to positive psychological experiences.

During the initial assessment of a 22-year-old pregnant client, the nurse learns that the client usually smokes 2 packs of cigarettes per day. The nurse is planning an education session about lifestyle changes during pregnancy. Which goal would be the most realistic and individualized for this client during this initial clinic visit? The client does some research on the harmful affects of cigarette smoking on the baby. The client throws the cigarettes in the trash immediately. The client stops smoking immediately for the health of the fetus. The client reduces her smoking by 50 percent by the next clinic visit.

The client reduces her smoking by 50 percent by the next clinic visit. When establishing goals and outcomes, the nurse should be certain that plans are individualized and realistic for a woman's situation and lifestyle and should try to turn long-term goals into more manageable, short-term ones. For example, a goal of reducing smoking during pregnancy may be more realistic than a goal of stopping smoking forever. This eliminates the pressure of making a major permanent lifestyle change. Sudden cessation of smoking is not beneficial because the woman will have to cope with withdrawal symptoms. The client will likely be noncompliant with this request. Having the client research smoking during pregnancy is also unrealistic during this initial visit. The client has to be motivated before the goal can be set.

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

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.

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? The intestines are displaced by the growing fetus. This shouldn't be happening. hCG is delaying peristalsis. There is not enough fiber in your diet.

The intestines are displaced by the growing fetus. The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis.

A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain? acetaminophen aspirin products naproxen ibuprofen

acetaminophen Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.

When measuring the diagonal conjugate of a woman's pelvis, the distance between which anatomic landmarks would be used? anterior surface of the sacral prominence and the anterior surface of the symphysis pubis interior surface of the sacral prominence and the posterior surface of the symphysis pubis medial surface of the ischial tuberosities posterior surface of sacrum and the axis of the ischial tuberosities

anterior surface of the sacral prominence and the anterior surface of the symphysis pubis The diagonal conjugate measures the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis, or the anterior-posterior diameter of the pelvic inlet.

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? halfway between the symphysis pubis and the umbilicus at the xiphoid process at the level of the umbilicus at the top of the symphysis pubis

at the level of the umbilicus 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.

What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)? thorax perineum breasts abdomen

breasts Montgomery glands (Montgomery tubercles) are sebaceous glands on the areola of the breasts and are prominent during pregnancy.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? bruising linea nigra striae darkening of the umbilicus

bruising Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.

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? white bread and rice deep red or orange vegetables meat, poultry, and fish dark, leafy green vegetables

dark, leafy green vegetables 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.

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to: remind her that she is still early in the pregnancy and she will feel better about it as the pregnancy progresses. tell her to move home so her family will be nearby to help her. offer to meet with the client on a regular basis to provide her someone to talk to about her concerns. encourage her to identify someone that she can talk to and share the pregnancy experience.

encourage her to identify someone that she can talk to and share the pregnancy experience. A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

A nurse assessing the laboratory results of a pregnant client in the second trimester notes that the client has a hemoglobin level of 11 g/dl (110 g/l). How will the nurse likely interpret this finding? multiple gestation pregnancy hemodilution of pregnancy (physiologic anemia of pregnancy) iron-deficiency anemia greater-than-expected weight gain

hemodilution of pregnancy (physiologic anemia of pregnancy) During pregnancy, the red blood cell (RBC) count increases along with an increase in plasma volume. However, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution of pregnancy, which is also called physiologic anemia of pregnancy. Changes in the pregnant client's iron levels would be more indicative of iron-deficiency anemia. Although anemia may be present with a multiple gestation pregnancy, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hemoglobin levels.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? inefficient protein metabolism constipation tooth fracture iron-deficiency anemia

iron-deficiency anemia Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

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 urinary frequency in the third trimester backache during the second trimester nausea with vomiting during the first trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester

lower abdominal pain with shoulder pain in the first trimester sudden leakage of fluid during the second trimester headache with visual changes in the third trimester 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 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 36 weeks, then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth

once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth 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/min blood pressure, 88/56 mm H g. 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/min blood pressure, 88/56 mm Hg blood urea nitrogen (BUN), 25 mg/dl (8.93 mmol/l) sodium 148 mEq/l (148 mmol/l) 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 client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: home pregnancy tests often give a false positive result. The test works best on a midday urine sample. Their reliability is only about 90%. some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period.

some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period. Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within 1 day after a missed period. These tests often give a false negative, not false positive, reading. Results can be tested with the first voided specimen of the day.

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant? ultrasound picture of her fetus continued amenorrhea positive hCG blood result uterine growth

ultrasound picture of her fetus A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? visualization of the fetus by ultrasound laboratory test of a urine specimen for hCG laboratory test of a blood serum specimen for hCG absence of a period

visualization of the fetus by ultrasound There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? "A one time discharge of bloody mucus in the toilet might have been your mucus plug." "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." "It might be nothing. If it happens again call your provider who is on-call." "Bloody mucus is a sign you are in labor. Please come to the hospital."

"A one time discharge of bloody mucus in the toilet might have been your mucus plug." Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy." "I need to gain less than 25 pounds (11 kg) during this pregnancy." "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy." "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy."

"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." A prepregnant BMI of 23 is in the normal category, and this client needs to gain 25 to 35 lbs (11 to 16 kg) during this pregnancy. Lower weight gain would be recommended for women with a BMI of over 25.

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 need to raise the head of my bed about 15 to 30 degrees." "I should lie down for 1/2 hour after eating." "I should chew my food slowly." "I need to cut out caffeine."

"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 pyrosis (heartburn) of pregnancy.

A nurse is educating a pregnant client about obtaining a blood sample for an alpha-fetoprotein (AFP) level. Which response by the client indicates that the health teaching was successful? "If my AFP level is low, then I won't need to follow up." "If there is a need to get my AFP level tested, a blood sample will be obtained around 11 weeks." "If my AFP level is high, it could mean there is a problem with my baby's spinal cord." "If my AFP level is negative, it means the baby has no birth defects."

"If my AFP level is high, it could mean there is a problem with my baby's spinal cord." An elevated AFP level in a pregnant client could indicate the presence of some type of spinal cord defect. Testing is usually performed around 16 to 18 weeks' gestation and requires follow-up. Because the AFP is a screening tool, the test may need to be repeated. An AFP test alone cannot guarantee that there are no other birth defects. Any level that is abnormal should be followed up.

A client at 40 weeks' gestation informs the nurse that she is tired of being pregnant. What is the best response from the nurse? "Are you getting enough rest? If you don't take time for rest, that is why you might be tired." "Do you need to speak with someone about your feelings?" "That is a very normal feeling, especially at this point in pregnancy." "Most woman would have asked to be induced by this point. Is that what you want?"

"That is a very normal feeling, especially at this point in pregnancy." During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities, and may feel ready to have the baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce labor is something that should be done in consultation with the health care provider and only when it is necessary for the health/safety of the mother or baby.

A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best? "Be calm. Why worry about things that likely won't happen?" "Your statistical risk of another tubal pregnancy is increased." "You should not worry about this right now—stress can harm the fetus." "Just because you had one ectopic pregnancy does not mean you will have another."

"Your statistical risk of another tubal pregnancy is increased." If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? 2 lb (0.90 kg) 1.5 lb (0.68 kg) 2/3 lb (0.30 kg) 1 lb (0.45 kg)

1 lb (0.45 kg) The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.

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

12.0 cm 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.

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? 2+ Protein in urine Trace of glucose Straw-like color Specific gravity of 1.010

2+ Protein in urine During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 32 cm 30 cm 24 cm 18 cm

24 cm 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.

Hormone levels of a woman indicate that the corpus luteum stopped functioning and releasing progesterone after 5 weeks. The nurse would recognize that which scenario is the expected outcome? A spontaneous abortion (miscarriage) would occur. The pregnancy would continue unaffected. She will need progesterone supplement throughout the pregnancy. There is a higher than normal chance of a multifetal pregnancy.

A spontaneous abortion (miscarriage) would occur. If the corpus luteum fails to produce progesterone for approximately 6 to 7 weeks, a spontaneous abortion (miscarriage) will occur. After 7 weeks, the placenta will produce enough progesterone to sustain the pregnancy. There is no connection between multifetal pregnancies and the corpus luteum not functioning long enough in progesterone production.

The nurse is reviewing rubella antibody testing results (above) for a pregnant client at 8 weeks' gestation. What action does the nurse anticipate based on these results? Administer the measles-mumps-rubella (MMR) vaccine postpartum. Administer the measles-mumps-rubella (MMR) vaccine after weaning. Administer the measles-mumps-rubella (MMR) vaccine in the third trimester. Administer the measles-mumps-rubella (MMR) vaccine as soon as possible.

Administer the measles-mumps-rubella (MMR) vaccine postpartum. A rubella IgG antibody index of 0.7 to 1.0 (7 to 10 international units/ml) is equivocal and an additional dose of measles-mumps-rubella (MMR) vaccine is indicated in order to develop sufficient immunity to rubella. The MMR vaccine is a live vaccine and cannot be given in pregnancy. It should be administered postpartum. Breastfeeding is not a contraindication to live vaccine administration; the MMR vaccination does not need to be deferred until after weaning.

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? Fetal nonstress test, Doppler assessment of fetal heart rate Amniocentesis, chorionic villus sampling, fetal nonstress test Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling 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.

The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet? Meats Grains Legumes Dairy

Meats Meats are the best source of heme-rich iron and should be included in her diet if she is not following a vegetarian diet. Grains and legumes are non-heme iron sources. Dairy products will add various vitamins and calcium to the diet.

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize? Sympathetic nerve responses cause dyspnea when a woman lies supine. Cerebral arteries are growing congested with blood. The uterus requires more blood in a supine position. Blood is trapped in the vena cava in a supine position.

Blood is trapped in the vena cava in a supine position. Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? The blood pressure should be higher since the cardiac volume is increased. Combined, both of these findings are very concerning and warrant further investigation. The heart rate increase may indicate that the client is experiencing cardiac overload. Both findings are normal at this point of the pregnancy.

Both findings are normal at this point of the pregnancy. A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

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. Ask her to complete a written questionnaire concerning her past and present status. Wait until she is in the examining room and prepared for her physical examination. Ask her some basic questions in the waiting room before taking her to the examining room.

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

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? Stop and rest every block. Reduce walking to half a block daily. Continue this as long as she enjoys it. Engage in aerobics for greater benefits.

Continue this as long as she enjoys it. Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy? Limit weight gain to less than 5 lb (2 kg) for the remainder of this pregnancy. Increase weight gain to 1.5 lb (0.68 kg) per week during this pregnancy. Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Watch the diet so no additional weight is gained during this pregnancy.

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.

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. Delay toothbrushing until noon. Take two aspirin on arising. Take a teaspoon of baking soda before breakfast.

Delay breakfast until mid-morning. 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 nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? Ask another nurse to assess the heart. Document this and continue to monitor the murmur at future visits. Inquire if the client has chest pain. Refer her for cardiac catheterization.

Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education? Blood pressure decreases in the third trimester. During pregnancy blood volume can increase by at least 40%. Hemoglobin levels rise significantly during pregnancy. Pregnancy typically causes a decrease in respiratory rate.

During pregnancy blood volume can by 40% The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid-pregnancy and, thereafter, increases to prepregnancy levels by the third trimester.

A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply. Eat a large amount of carbohydrates. Do not eat fried, fatty foods. Eat five to six small meals per day. Do not drink liquids with meals. Do not lie down immediately after eating.

Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating. The client is experiencing pyrosis. Eating small frequent meals, avoiding fried foods, and not laying down immediately after eating will minimize the discomfort. Large quantities of carbohydrates and not taking liquids with meals will not change the discomfort being experienced.

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? Varicose veins Gastrointestinal reflux Hemorrhoids Umbilical hernia

Hemorrhoids The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.

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 P0021 G2 P0020 G2 P1020 G3 P0020

G3 P0020 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.

The nurse is documenting a non-pregnant client's obstetric history. The client informed the nurse she has 4 children living at home. She birthed one child at 34 weeks' gestation, one child at 37 weeks' gestation, one at 38 weeks' gestation, and one at 39 weeks' gestation. The client has had one abortion. Using the GTPAL format, how will the nurse document the client's obstetric history? G4, T3, P1, A1, L4 G4, T3, P0, A1, L3 G5, T2, P2, A1, L4 G5, T2, P1, A1, L3

G5, T2, P2, A1, L4 "G" stands for gravida, the total number of pregnancies (5). "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation)(2). "P" is for preterm, the number of pregnancies that ended after 20 weeks' gestation (2). "A" is for abortions, either spontaneous or elective (1). "L" is for living, the number of children delivered who are alive at the time of history collection (4).

A pregnant woman's husband does not voice concerns at prenatal visits. Which observation would lead the nurse to suspect that the husband is emotionally involved in the pregnancy? He states he definitely wants a girl. He states he is concerned about the loss of his free time. He walks around furniture as if his abdomen is enlarged. He has refused to paint the baby's room blue.

He walks around furniture as if his abdomen is enlarged. Many partners experience physical symptoms such as nausea, vomiting, and backache to the same degree or even more intensely than their partners during a pregnancy; some begin to gain weight along with their partner. This is known as couvade syndrome. As a woman's abdomen begins to grow, partners may perceive themselves as growing larger too, as if they were the ones who were experiencing changing boundaries the same as the pregnant woman. These symptoms apparently result from stress, anxiety, and empathy for the pregnant woman. Men who identify with their wife's pregnancy may act as if their abdomen is enlarging, the same as they may take on nausea of pregnancy.

A woman comes to the prenatal clinic and undergoes a pelvic exam. The doctor notes a softening of the uterine isthmus. The nurse recognizes that this finding is known as what sign? Chadwick sign Hegar sign Goodell sign Quickening

Hegar sign The Hegar sign is one of three signs that can be noted by a digital pelvic exam and involves the softening of the lower uterine segment. This is one of the probable signs of pregnancy, along with a positive Chadwick sign and Goodell sign.

What would the nurse recommend to a pregnant client at 35 weeks' gestation who reports irregular contractions and lower backache? Have a family member rub her back and place moist heat on it. Suggest that she try some isometric exercises to relieve the back pain. Ask her if she is having urinary frequency that may indicate an infection. Lie down and rest and see if the contractions stop and pain subsides.

Lie down and rest and see if the contractions stop and pain subsides. If a client is less than 37 weeks and having contractions that will not go away, she may be in preterm labor and this needs to be reported. The first thing for her to do is lie down and rest to see if the contractions go away. Lower backache and cramping or pain need to be taken seriously and reported to the health care provider if they persist.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include? Using herbs will help ease the discomfort. Most of the hormonal changes are permanent after the pregnancy is completed. Taking hormonal replacement therapy can improve the discomfort of the changes. Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids will usually relieve the symptoms but should be discussed with the health care provider first. The hormonal changes are necessary for the pregnancy to continue, and the woman will return to her usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy is not recommended. Using herbs should be done only with the knowledge of the health care practitioner due to the side effects and contraindications of some herbs during pregnancy. Some herbs will cause a spontaneous abortion (miscarriage).

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? Keep the head of the client's bed slightly elevated. Place the client in an orthopneic position. Keep the client's legs slightly elevated. Place the client in the left lateral position.

Place the client in the left lateral position. The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

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? Lateral movement of the kneecap Presence of varicosities Diameter of the calf muscle Blanching and refilling of toenails

Presence of varicosities 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 nursing instructor is teaching a class on the various hormones necessary for a successful pregnancy and birthing process. The instructor determines the session is successful when the students correctly choose which hormone as being necessary after birth to ensure growth of the newborn? Estrogen Prolactin Progesterone Oxytocin

Prolactin Prolactin is the hormone responsible for the initiation of lactation, the production of breast milk. Oxytocin is responsible for the letdown of milk and uterine contractions enabling the infant to be born, and estrogen and progesterone are responsible for uterine and pregnancy maintenance.

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client reports varicosities of the legs. Which instruction should the nurse provide to help the client alleviate varicosities of the legs? Refrain from wearing any kind of stockings. Apply heating pads on the extremities. Refrain from crossing legs when sitting for long periods. Avoid sitting in one position for long periods of time.

Refrain from crossing legs when sitting for long periods. To help the client alleviate varicosities of the legs, the nurse should instruct the client to refrain from crossing her legs when sitting for long periods. The nurse should instruct the client to avoid standing, not sitting, in one position for long periods of time. The nurse should instruct the client to wear support stockings to promote better circulation, though the client should stay away from constrictive stockings and socks. Applying heating pads on the extremities is not reported to alleviate varicosities of the legs.

A pregnant client at 33 weeks' gestation is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she feels lightheaded; her blood pressure is 82/58 mm Hg. What is the most likely explanation for this problem? She did not drink enough fluids prior to coming to the office. Her hematocrit is low and she needs additional iron supplements. She is experiencing supine hypotension syndrome The baby is kicking her spinal column, causing a pinched nerve.

She is experiencing supine hypotension syndrome As the uterus gets larger toward the end of the pregnancy, it presses the aorta and vena cava against the spine, causing decreased blood return to the heart. This reduces cardiac output and the woman may feel lightheaded and dizzy and her blood pressure will drop.

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next? Notify the health care provider of a possible infection. Tell the woman that this is entirely normal. Advise the woman about the need to culture the discharge. Check the discharge for evidence of ruptured membranes.

Tell the woman that this is entirely normal. Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.

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 a screening for neural tube defects. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a blood test to detect placental problems. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. 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 nurse is assisting a pregnant client who underwent a nonstress test that was ruled reactive. Which factor will the nurse point out when questioned by the client about the results? The fetus is developing at a fast rate but doing fine. The results indicate a stress test is needed for further evaluation. There is no evidence of congenital anomalies or deformities. The fetal heart rate increases with activity and indicates fetal well-being.

The fetal heart rate increases with activity and indicates fetal well-being. A nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity, and this indicates fetal well-being. This test is not used to determine congenital anomalies or deformities. It does not determine the speed by which fetus is developing. Further evaluation would be necessary if the results were nonreactive.

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? cretinism pregnancy syndrome couvade syndrome pseudo pregnancy

couvade syndrome Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

The nurse is meeting with a client at 28 weeks' gestation. To prepare her for the final trimester, which factor should the nurse prioritize in the teaching session? preventing varicosities decreasing bleeding gums decreasing shortness of breath preventing anemia

decreasing shortness of breath As the fetus grows inside the mother, there is more pressure on the diaphragm, more difficulty breathing, and episodes of dyspnea may occur. This tends to decrease with "lightening," when the fetus drops. Preventing anemia, decreasing bleeding gums, and preventing varicosities are situations that should be addressed throughout the entire pregnancy.

Which finding is most worrisome in a client in her 26th week of pregnancy? a hyperpigmented rash over the maxillary region bilaterally generalized hair loss nosebleeds facial edema

facial edema Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy? fetal heartbeat positive urine human chorionic gonadotropin (hCG) uterine size and shape changes Chadwick sign

fetal heartbeat The only positive sign of pregnancy is a sign or symptom that could only be attributable to the fetus; thus, fetal heartbeat can have no other origin. Chadwick sign is a color change in the cervix, vagina, and perineum; these could all be the result of other causes. A positive urine hCG is a probable sign as it can be related to causes other than pregnancy. A change in the size and shape of the uterus can occur due to other causes.

What is a positive sign of pregnancy? uterine contractions Hegar sign fetal movement felt by examiner positive pregnancy test

fetal movement felt by examiner The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and the examiner feeling fetal movement.

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. morning sickness amenorrhea ultrasound pictures fetal heartbeat breast changes hydatidiform mole

morning sickness amenorrhea breast changes Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone? relaxin estrogen progesterone human placental lactogen

relaxin Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilation (dilatation) at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective and thereby allowing more glucose to become available for fetal growth.