final antepartum review ob 2020 fall

A pregnant woman at 8 weeks' gestation is scheduled for a transvaginal ultrasound. After teaching has been completed, which statements indicate understanding? Select all that apply. "I will need to drink fluids before the procedure." "I will need a catheter placed in my bladder to aid in the procedure." "I will be able to see my fetus's heart beating during the test." "I will have gel placed on my abdomen prior to starting the procedure." "A small wand shaped probe will be placed in my vagina."

"A small wand shaped probe will be placed in my vagina." "I will be able to see my fetus's heart beating during the test." Explanation: A transvaginal ultrasound can be used in pregnancy during the first trimester. It is not considered appropriate after that point. The transvaginal ultrasound requires that a slender probe is placed in the vagina. It is able to determine if the pregnancy is viable. The fetal heart beat will present by this point in the pregnancy. A full bladder is not needed for the transvaginal ultrasound. There is no needed oral fluid intake for this procedure. There is no need for an indwelling catheter to be placed in the bladder for the transvaginal ultrasound.

At a prenatal class, the participants ask the nurse who would benefit from genetic counseling. Which responses by the nurse are correct? Select all that apply. "A young teenager experiencing her first pregnancy." "A woman who receives an abnormal alpha-fetoprotein result." "A woman who is a grand multigravida." "A woman whose husband is age 50 years or older." "A woman who has been exposed to teratogens."

"A woman whose husband is age 50 years or older." "A woman who has been exposed to teratogens." "A woman who receives an abnormal alpha-fetoprotein result." Explanation: Those shown to benefit from genetic counseling are women over the maternal age 35 years or older when the baby is born; couples where the paternal age is 50 years or older; when a pregnancy screening abnormality is noted, including the alpha-fetoprotein. Genetic screening is encouraged where there has been teratogen exposure or risk. Teenage pregnancies or having multiple pregnancies do not qualify for genetic counselling unless the above risks have been identified.

A pregnant client at 26 weeks' gestation has arrived for a routine prenatal visit. Which assessments should the nurse prioritize? Select all that apply. blood glucose level urine testing weight edema of the face and hands blood pressure

"At least 8 glasses of water daily is needed to maintain hydration." "Taking in at least 1000 mg of calcium daily is important during pregnancy." "Taking my daily iron supplement is key to the health of my pregnancy." Explanation: Dietary intake in pregnancy is important to the health and wellness of the mother and fetus. At least 8 glasses of water daily is needed to maintain hydration. Calcium needs are 1000 mg daily. The daily prenatal vitamin is needed to ensure adequate iron intake. A balanced diet in pregnancy is needed. Protein needs in pregnancy do increase, but they do not double. Limitations to sodium intake are not indicated in the absence of other problems.

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

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

A client who is six weeks' pregnant asks the prenatal nurse, "What development has taken place with my baby by now?" Which information should the nurse include in the response? Select all that apply. "By week 6 the lungs begin forming and the baby circulation is established." "By week 4 the arms and legs begin to grow and develop." "By week 6 the baby makes active movements with sucking motions made with the mouth." "By week 3 there would be the beginning development of the brain, spinal cord, and heart." "By week 5 the heart now beats and the eyes and ears can be seen."

"By week 3 there would be the beginning development of the brain, spinal cord, and heart." "By week 4 the arms and legs begin to grow and develop." "By week 5 the heart now beats and the eyes and ears can be seen." "By week 6 the lungs begin forming and the baby circulation is established." Explanation: By week 3 there is the beginning development of brain and spinal cord, and the heart becomes more developed. Limb buds grow and develop at week 4. By week 5 the heart now beats at a regular rhythm. Beginning structures of eyes and ears are seen. Week 6 shows the lungs beginning to form and fetal circulation is established. At weeks 13 to 16 the fetus will make active movement, not at week 6. Sucking motions are made with the mouth in week 12, not in week 6.

A pregnant woman notices that sometimes her heartbeat is irregular when she is lying down resting on her back. The provider suspects she is experiencing low blood pressure. Which intervention would the health care provider suggest to the woman to prevent this from occurring? Select all that apply. × "This is a normal experience, and it will go away after birth." × × × "Change positions slowly to allow pooled blood to reenter the circulation slowly." × × × × "Try sleeping and resting on your side with a small pillow between the knees." × "Try sleeping on your stomach with pillows to support your lower limbs." × × "Drink extra water before lying down for a rest." ×

"Change positions slowly to allow pooled blood to reenter the circulation slowly." × "Try sleeping and resting on your side with a small pillow between the knees." × Explanation: To prevent vena cava syndrome caused by pressure on the vena cava in the supine position, advise pregnant women to always rest or sleep on their side, not their back. If a woman rises suddenly from a lying position, she may faint from the same phenomenon (blood pooling in the pelvic area or lower extremities). Rising slowly and avoiding extended periods of standing prevents this problem. It is not advised for a pregnant woman to sleep on her stomach. Excess fluid intake will not affect this symptom since the cause is due to uterine pressure on the inferior vena cava. It is a common problem, but it should be prevented if at all possible to minimize low blood flow and anoxia in the fetus.

The nurse is conducting a comprehensive initial assessment of a pregnant client during a prenatal visit. When assessing the client's social history, what questions should the nurse include? Select all that apply. "Do you currently use tobacco?" "What do you currently do for employment?" "Do you have any chronic health problems?" "Have you ever been hospitalized?" "Who do you have in your life who can support you?"

"What do you currently do for employment?" "Do you currently use tobacco?" "Who do you have in your life who can support you?" Explanation: Employment status, social support and substance use are within the scope of the social history. Hospitalizations and health problems are part of the client's medical-surgical history.

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestion(s) by the nurse is helpful? Select all that apply. Complete moderate exercise daily. Keep legs below the level of the heart. Wear compression stockings. Avoid sudden position changes. Limit fluid intake to 1 liter daily.

Complete moderate exercise daily. Wear compression stockings. Explanation: Suggestions of exercising and wearing compression stockings are most helpful to the client with lower extremity edema and varicose veins. It is also helpful to have frequent rest periods with the legs elevated above the heart. Fluid intake is not to be limited. Avoiding sudden position changes helps prevent round ligament pain.

The client at 32 weeks' gestation expresses concern regarding lower extremity edema and bulging leg veins. Which suggestions by the nurse are helpful? Select all that apply. Complete moderate exercise daily. Limit fluid intake to 1 liter daily. Wear compression stockings. Avoid sudden position changes. Keep legs below the level of the heart.

Complete moderate exercise daily. Wear compression stockings. Explanation: Suggestions of exercising and wearing compression stockings are most helpful to the client with lower extremity edema and varicose veins. It is also helpful to have frequent rest periods with the legs elevated above the heart. Fluid intake is not to be limited. Avoiding sudden position changes helps prevent round ligament pain.

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which action should the nurse suggest? Select all that apply.

Eat some saltine crackers before rising in the morning. Suck on sour candies. Delay breakfast until 10 or 11 AM. Try eating a snack before bedtime Explanation: The traditional solution for preventing nausea is for women to keep dry crackers, such as saltines, by their bedside and eat a few before rising, as increasing carbohydrates seems to relieve nausea better than any other nutritional remedy. Sucking on sour candies may serve the same purpose. A woman can then eat a light breakfast or delay breakfast until 10 or 11 am, past the time her nausea seems to persist. To be certain she maintains a good food intake during pregnancy even in the face of nausea, urge her to compensate for any missed meals later in the day; thus, eating two regular meals later in the day would not be adequate and could lead to hypoglycemia. Caution women against self-medicating for nausea by using a scopolamine patch (a drug used for motion sickness) as it is not intended for long-term use. Eating a snack before bedtime may be helpful so that delaying breakfast won't cause the woman to go a long time between meals.

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

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

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply. Sit in a hot tub at least three times a week. Use thigh-high support hose. Use knee-high support hose. Walk daily. Elevate the feet and legs.

Elevate the feet and legs. Walk daily. Use thigh-high support hose. Explanation: Vascular changes during pregnancy manifested in the integumentary system include varicosities of the legs, vulva, and perineum. Varicose veins commonly are the result of distention, instability, and poor circulation. Various interventions to reduce the risk of developing varicosities include elevating both legs when sitting or lying down; avoiding prolonged standing or sitting; walking daily for exercise; avoiding tight clothing or knee-high hosiery; and wearing support hose if varicosities are a preexisting condition to pregnancy.

Which action(s) will the nurse advocate for childbearing clients to help the nation achieve the 2030 National Health Goals? Select all that apply. Encourage the client to begin prenatal care early and continue visits. Provide the client with information on how to increase folic acid intake. Screen the client for postpartum depression at the postpartum check-up. Schedule the client for weekly ultrasound examinations to detect fetal abnormalities. Educate the client about receiving the Tdap vaccination during pregnancy.

Encourage the client to begin prenatal care early and continue visits. Educate the client about receiving the Tdap vaccination during pregnancy. Screen the client for postpartum depression at the postpartum check-up. Provide the client with information on how to increase folic acid intake. Explanation: Nurses can help achieve the 2030 National Health Goals by urging women to enter pregnancy with an adequate folic acid level, ensuring women obtain early and adequate prenatal care, encouraging the client to obtain the Tdap vaccine during pregnancy, and screening clients for postpartum depression at the postpartum visit. Frequent ultrasound/sonogram examinations are not necessary and may be harmful.

What physiological changes would be noted in a pregnant woman? Select all that apply. Increased hemoglobin and hematocrit Enlarged pituitary gland Decreased prolactin levels Delayed gastric emptying and decreased peristalsis Lordosis

Enlarged pituitary gland Lordosis Delayed gastric emptying and decreased peristalsis Explanation: During pregnancy, the pituitary gland increases in size ~35% to accommodate the increased need of the hormones being produced. Lordosis occurs to counterbalance the protuberant abdomen of the pregnant woman. Due to the increased uterine size that protrudes into the abdominal cavity and decreased motility, decreased gastric emptying may occur leading to heartburn and decreased peristalsis, which leads to constipation.

A physically fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which instructions should the nurse give to the client? Select all that apply. Try walking, which is an excellent exercise option during pregnancy. Include warm-up and cool-down exercises. Avoid exercises that involve movements of large muscle groups rhythmically. Avoid taking up a new sport, such as cycling, during pregnancy. Exercise three times weekly for 30 consecutive minutes. Avoid sports that involve body contact.

Exercise three times weekly for 30 consecutive minutes. Include warm-up and cool-down exercises. Avoid sports that involve body contact. Avoid taking up a new sport, such as cycling, during pregnancy. Try walking, which is an excellent exercise option during pregnancy. Explanation: As a rule, average, well-nourished women should exercise during pregnancy about 3 times weekly for 30 consecutive minutes. Their exercise program should consist of 5 minutes of warm-up exercises, an active "stimulus" phase of 20 minutes, and then 5 minutes of cool-down exercises. Movements that exercise large muscle groups rhythmically, such as walking, are best, but the type of activity chosen should depend on their interests. She should avoid sports that involve body contact, taking up a new sport, and jogging, all of which would put her at greater risk for injury.

A pregnant client at 18 weeks' gestation has arrived for her routine prenatal visit. Which assessment findings should the nurse prepare to document at this time? Select all that apply. Fundal height of approximately 18 cm Leg cramps Quickening Braxton Hicks contractions Insomnia

Fundal height of approximately 18 cm Quickening Explanation: Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton Hicks contractions, and leg cramps are common during the third trimester.

What physical changes take place when a woman becomes pregnant? Select all that apply. The uterus becomes pear-shaped. Nasal congestion increases due to edema. Heart rate increases 10 to 15 beats per minute. The areolae become more prominent. Respiratory rate increases 20%.

Heart rate increases 10 to 15 beats per minute. The areolae become more prominent. Nasal congestion increases due to edema. Explanation: The pregnant uterus is globular shaped, not pear-shaped. The heart rate usually increases 10 to 15 beats per minute over the prepregnancy rate of 60 to 100 beats per minute. The respiratory rate is essentially unchanged. The areolae of the breasts become more prominent with a deepened pigmentation. Mothers report that they experience more nasal congestion during pregnancy that occurs secondary to edema found in the nasal passages.

A prenatal nurse is conducting a class on healthy pregnancy and explains the role of placental hormones. Which statements would the nurse make? Select all that apply. Human placental lactogen participates in the development of maternal breasts for lactation. Thyroxin modulates fetal and maternal metabolism. Relaxin causes enlargement of a woman's breasts, uterus, and external genitalia. Estrogen causes enlargement of a woman's breasts. Human chorionic gonadotropin is the basis for pregnancy tests. Progesterone stimulates maternal metabolism and breast development.

Human chorionic gonadotropin is the basis for pregnancy tests. Human placental lactogen participates in the development of maternal breasts for lactation. Progesterone stimulates maternal metabolism and breast development. Estrogen causes enlargement of a woman's breasts. Explanation: Human chorionic gonadotropin is the basis for pregnancy tests. Human placental lactogen modulates fetal and maternal metabolism and participates in the development of maternal breasts for lactation. Estrogen (estriol) causes enlargement of a woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone (progestin) maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal metabolism and breast development. Relaxin acts with progesterone to maintain pregnancy and causes relaxation of the pelvic ligaments. Progesterone maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal metabolism and breast development. Thyroxin is not a placental hormone.

Which physical change would the nurse expect to find in a pregnant client? Select all that apply. Supine hypotension Decreased clotting factors Increased hemoglobin Increased blood volume Negative Hagar sign

Increased blood volume Supine hypotension Explanation: The pregnant client will experience blood volume increases of 40-45% over prepregnancy levels. Supine hypotension occurs when the pregnant client lies down on her back in the latter half of the pregnancy and the uterus pushes down on the aorta and vena cava, decreasing cardiac return. The hemoglobin decreases due to physiologic hemodilution. The blood clotting factors increase during pregnancy, not decrease. A positive Hagar sign is one of the presumptive signs of pregnancy.

A gravid client is talking with the nurse about the excessive nausea and vomiting she has been experiencing throughout the day. She asks why this is happening to her and what she can do to reduce the nausea. What information should be included in the nurse's response? Select all that apply. The changes in progesterone in pregnancy are associated with high levels of nausea in pregnancy. Eating a high carbohydrate snack before getting out of bed may be helpful. The levels of estrogen normally seen in pregnancy are associated with nausea and vomiting. Limiting fluid intake during the morning and evening hours has been shown to reduce nausea in pregnancy. Ingesting small frequent meals in pregnancy is helpful to manage nausea.

Ingesting small frequent meals in pregnancy is helpful to manage nausea. Eating a high carbohydrate snack before getting out of bed may be helpful. Explanation: Nausea and vomiting in pregnancy is associated with elevated human chorionic gonadotropin (hCG) levels. Progesterone and estrogen levels are elevated in pregnancy but the normal levels associated with pregnancy are not linked to an increased occurrence of nausea and vomiting. Unusually elevated hormone levels, however, are associated with increased incidents of nausea and vomiting. Eating small frequent meals instead of large bulky meals can assist with the nausea. Ingesting a high carbohydrate snack such as crackers before arising from bed in the morning is also associated with reduced levels of nausea.

A nurse is describing the development of the fetus to a group of pregnant women. When describing the function of the placenta, which information would the nurse most likely include? Select all that apply. It cushions the fetus against injury. It permits blood to bypass the right ventricle. It protects the umbilical cord. It carries waste away for excretion by the mother. It supplies oxygen and nutrients to the fetus. It produces hormones that help maintain the pregnancy.

It supplies oxygen and nutrients to the fetus. It produces hormones that help maintain the pregnancy. It carries waste away for excretion by the mother. Explanation: The placenta supplies the developing organism with food and oxygen, carries waste away for excretion by the mother, slows the maternal immune response so that the mother's body does not reject the fetal tissues, and produces hormones that help maintain the pregnancy. Wharton's jelly protects the umbilical cord and the foramen ovale permits most of the blood to bypass the right ventricle. The amniotic fluid cushions the fetus against injury.

The nurse is leading a preconception education session at the community center. A participant asks: "I heard you shouldn't eat unpasteurized milk or cheese while pregnant. Is that true?" The nurse respond that these foods should be avoided because they may be contaminated with which substance that is harmful during pregnancy? Select all that apply. Listeria Toxoplasmosis Mercury Salmonella E. Coli

Listeria Salmonella E. Coli Explanation: Unpasteurized milk and cheese may be contaminated with listeria, salmonella or E. Coli, which cause gastrointestinal distress in an adult but may cause miscarriage or stillbirth during pregnancy. Large fatty fish are contaminated with mercury; toxoplasmosis comes from eating raw meats.

An obstetrical nurse is conducting a program for pregnant women who are in their first trimester. The program focuses on the changes occurring in the woman's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply. Maternal metabolic changes to make nutrients available for mother and fetus Decrease in blood supply to the gastrointestinal tract and slowing of peristaltic waves Preparing the breasts for lactation, keeping the milk from coming in until birth occurs Decrease in maternal blood volume and red blood cell mass to increase oxygen delivery Maintenance of the endometrium so that the embryo can implant Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly

Maintenance of the endometrium so that the embryo can implant Maternal metabolic changes to make nutrients available for mother and fetus Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly Preparing the breasts for lactation, keeping the milk from coming in until birth occurs Explanation: The hormonal effects of pregnancy include the following: • Maintaining the endometrium so that the embryo can implant, causing changes in the mother's metabolism so that nutrients are available for both • Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly • Preparing the breasts for lactation, keeping the milk from coming in until birth occurs • Increasing the mother's blood volume and red blood cell mass to increase oxygen • Increasing the blood supply to the gastrointestinal tract and slowing peristaltic waves

A 17-year-old woman has become pregnant as her boyfriend refused to wear condoms. The boyfriend calls her names, often becomes jealous and, although rare, sometimes hits her. Which condition is this pregnant client most at risk of developing in this pregnancy? Select all that apply. Postterm pregnancy Small-for-gestational-age infant Sexually transmitted infection Placental abruption (abruptio placentae) Preterm birth

Placental abruption (abruptio placentae) Small-for-gestational-age infant Preterm birth Sexually transmitted infection Explanation: Intimate partner violence increases the risk for placental abruption (abruptio placentae), preterm birth, and small-for-gestational-age infant during pregnancy. Because the couple have been having unprotected sex, there is a risk for acquiring a sexually transmitted infection. Intimate partner violence does not influence the potential for a postterm pregnancy.

What are the probable signs of pregnancy that would be noted in a woman? Select all that apply. Breast tenderness Visualization of the gestational sac Amenorrhea Positive Goodell sign Ballottement

Positive Goodell sign Ballottement Explanation: Probable signs of pregnancy include objective data such as the Goodell sign, which is cervical softening. Another probable sign is ballottement, which is when the examiner pushes against the uterine wall and it bounces back. Breast tenderness and amenorrhea are presumptive signs and visualization of the gestational sac is a positive sign of pregnancy.

The nurse is documenting subjective and objective data changes from a client at 34 weeks' gestation. Which would the nurse report immediately to the health care provider? Select all that apply. Frequent nosebleeds Feeling faint Sharp abdominal pain Scant spotting on underwear Difficulty sleeping Bleeding gums

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

The nurse is explaining the ultrasound procedure to a pregnant client and mentions part of the purpose is to evaluate the amniotic fluid. When questioned by the client how the amniotic fluid helps the fetus, which functions should the nurse point out? Select all that apply. Helps permit symmetrical growth Provides physical protection Helps regulate temperature Produces necessary hormones Provides unrestricted movement

Provides physical protection Helps regulate temperature Provides unrestricted movement Helps permit symmetrical growth Explanation: Amniotic fluid fills the amniotic cavity. It serves four main functions for the fetus: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth. The amniotic fluid does not produce hormones. Hormones are produced by the placenta.

A young mother in a prenatal class asks the nurse why there is amniotic fluid in the uterus with her baby. Which functions of the amniotic fluid should the nurse point out to the client? Select all that apply. Maintains the endometrial lining of the uterus Stimulates uterine growth to accommodate the developing fetus Shields the fetus against pressure or a blow to the mother's abdomen Contributes to mammary gland development in preparation for lactation Protects the fetus from changes in temperature

Shields the fetus against pressure or a blow to the mother's abdomen Protects the fetus from changes in temperature Explanation: The most important purpose of amniotic fluid is to shield the fetus against pressure or a blow to the mother's abdomen. Because liquid changes temperature more slowly than air, it also protects the fetus from changes in temperature. And yet another function, it aids in muscular development, as amniotic fluid allows the fetus freedom to move. Finally, it protects the umbilical cord from pressure, protecting the fetal oxygen supply. It is progesterone that maintains the endometrial lining of the uterus. It is estrogen that contributes to mammary gland development in preparation for lactation and stimulates uterine growth to accommodate the developing fetus.

A client's recent prenatal ultrasound assessment reveals a normal placenta. Which outcomes would the nurse expect? Select all that apply. The placenta protects the fetus from an immune attack created by the mother. The placenta produces hormones that ready the fetus for extrauterine life. The hormones made by the placenta support fetal growth. The placenta will filter out toxins that the mother ingests. The placenta removes the fetal waste products such as stool.

The hormones made by the placenta support fetal growth. The placenta protects the fetus from an immune attack created by the mother. The placenta produces hormones that ready the fetus for extrauterine life. Explanation: The placenta will not filter out all toxins. The placenta begins to make hormones that control the basic physiology of the mother so the fetus is supplied with the nutrients and oxygen needed for growth. The placenta also protects the fetus from immune attack by the mother and removes waste products from the fetus. The placenta produces hormones that ready fetal organs for life outside the uterus.

At a prenatal class, the nurse educator describes the function of the placenta. What information would the nurse likely include? Select all that apply. The placenta stimulates the mother to bring more food to the placenta. The placenta produces hormones that ready fetal organs for life outside the uterus. The placenta ensures that the fetus is protected from all teratogens. The placenta removes the waste products that the fetus produces. The placenta makes hormones to control the way the fetus is supplied with nutrients and oxygen. The placenta acts as a barrier between the mother and fetus.

The placenta makes hormones to control the way the fetus is supplied with nutrients and oxygen. The placenta removes the waste products that the fetus produces. The placenta stimulates the mother to bring more food to the placenta. The placenta produces hormones that ready fetal organs for life outside the uterus. Explanation: The placenta acts as a pass-through between the mother and fetus to help supply the fetus with the nutrients and oxygen needed for growth. The placenta removes waste products from the fetus, induces the mother to bring more food to the placenta, and, near the time of birth, produces hormones that ready fetal organs for life outside the uterus. The placenta is not a barrier. Almost everything the mother ingests passes through to the developing fetus, and thus the fetus is not protected from teratogens.

A nurse is conducting a prenatal class for expectant mothers and one of them asks how the placenta works. The nurse would explain that the placenta serves which purposes? Select all that apply. It serves as a barrier to some medications and hormones in the maternal blood supply. It serves as an exchange site for oxygen and carbon dioxide. The placenta helps physically protect the fetus by surrounding the fetus with fluids. It releases insulin into the amniotic fluid for fetal usage. The placenta provides nourishment for the fetus.

The placenta provides nourishment for the fetus. It serves as an exchange site for oxygen and carbon dioxide. It serves as a barrier to some medications and hormones in the maternal blood supply. Explanation: The placenta serves three main functions: transfer and exchange of substances such as nutrients and waste products; production of hormones; and to act as a barrier to certain substances. It does not provide physical protection for the fetus nor does it release insulin into the amniotic fluid for fetal use.

A pregnant woman reports her last child was born by cesarean birth. She questions if she will be required to have a cesarean birth for this current pregnancy. What information should be provided? Select all that apply. The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. It is safe for women who have had a cesarean birth to have a vaginal birth if that is what she chooses. If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated. If the previous cesarean birth was due to fetal distress a repeated cesarean birth will be needed. The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed.

The reason for the previous cesarean birth will aid in determining if a repeated cesarean birth will be performed. The type of incision into the uterus in the previous cesarean birth will be a factor for consideration. If the cesarean birth was due to pelvic size a repeated cesarean birth is likely indicated. Explanation: A woman who gives birth by cesarean may be a candidate for a future birth vaginally. The determination about the method of birth for a future birth will be based upon a series of factors. The underlying reason for the cesarean birth has a large impact. If the woman had an operative birth due to small pelvic size, structural deformities or contractures, a repeated cesarean birth will likely be indicated. This is because the problems will still be present in the next pregnancy. The type of incision on the uterus is also an important factor. If the uterine incision was a classical incision, a repeated cesarean is indicated. The classic incision places the uterus at a high risk for rupture. If the cesarean birth was due to fetal distress, the woman may be a candidate for a vaginal birth after cesarean birth.

What purpose does amniotic fluid serve in fetal development? Select all that apply. Reservoir for fetal urine and respiratory tract secretions Exchange and transfer of substances To allow the fetus to move about in-utero Supply oxygen to the fetus Serves as an endocrine gland to produce hormones

To allow the fetus to move about in-utero Reservoir for fetal urine and respiratory tract secretions Explanation: Amniotic fluid serves as a protector for the fetus by allowing the fetus to move about in the uterus; the amniotic fluid physically protects the fetus. It also collects substances from the fetal gastrointestinal, urinary and respiratory tracts, which can be used for diagnostic studies.

A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply. increased blood pressure a uterus that is palpable colostrum that can be expelled from the nipples linea nigra and melasma (chloasma) varicosities of the vulva, rectum, and/or legs

a uterus that is palpable colostrum that can be expelled from the nipples Explanation: A uterus is palpable by the end of the 12th week of pregnancy, and by the 16th week of pregnancy colostrum can be expelled from the nipples. Blood pressure in women usually does not rise because the increased heart action takes care of the greater amount of circulating volume. Because of melanocyte-stimulating hormone from the pituitary, extra pigmentation can lead to linea nigra and melasma (chloasma) about the 24th week of pregnancy. Varicosities in the vulva, rectum, and legs tend to occur in the third trimester due to the pressure of the expanding uterus.

A nurse is conducting a class for a group of women who are planning on becoming pregnant. As part of the class, the nurse describes how teratogens can affect a pregnancy. The nurse determines that the teaching was successful when the class identifies which effects that may result with the use of cocaine? Select all that apply. premature birth abruptio placenta limb malformations intrauterine growth restriction microcephaly

abruptio placenta premature birth microcephaly Explanation: Cocaine use during pregnancy can lead to abruptio placenta, premature birth, and microcephaly. Intrauterine growth restriction is associated with the use of ACE inhibitors for treating hypertension. Limb malformations are associated with thalidomide exposure.

A pregnant client at 26 weeks' gestation has arrived for a routine prenatal visit. Which assessments should the nurse prioritize? Select all that apply. blood glucose level urine testing weight edema of the face and hands blood pressure

blood pressure weight urine testing blood glucose level Explanation: Up to the 28th week of gestation, follow-up visits involve assessment of the client's blood pressure and weight, urine testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks' gestation; however, edema of the face and hands should be reported if noted sooner.

After teaching a woman about the importance of folic acid in pregnancy, the nurse determines that the teaching was successful when the woman identifies which food(s) as being high in folic acid? Select all that apply. broccoli spinach apples almonds oranges

broccoli spinach oranges Explanation: Good food sources of folic acid include dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. Apples and almonds are not necessarily high in folic acid.

A pregnant client reports being unable to find snacks at work. Which snacks would the nurse recommend she prepare in advance to take to work? Select all that apply. pretzels and mustard carrot sticks doughnuts and juice candy bar with almonds cheese and crackers

carrot sticks cheese and crackers Explanation: Carrots sticks and cheese and crackers are nutrient-dense snacks. Pretzels and mustard, doughnuts and juice, and a candy bar with almonds all have a high calorie-to-nutrient ratio.

A 40-year-old client is in her 10th week of pregnancy. So far, her pregnancy appears to be healthy, with no abnormal results from standard diagnostic tests. Because of her age, however, the nurse would anticipate that the client is a candidate for which diagnostic tests? Select all that apply. maternal serum screening cell-free DNA testing amniocentesis nuchal translucency screening chorionic villus sampling

chorionic villus sampling amniocentesis cell-free DNA testing Explanation: Chorionic villus sampling (CVS), amniocentesis, and cell-free DNA testing are all techniques that may be offered to women who are older than 35 years of age, or to those whose triple/quadruple screen is abnormal, to further screen for genetic disorders. CVS is generally performed 10 to 13 weeks after the LMP. Women of all ages are offered routine sonogram screening (a nuchal translucency scan) and analysis of maternal serum levels of alpha-fetoprotein (MSAFP) by a quadruple screen early in pregnancy to evaluate for neural tube, abdominal wall, or chromosomal disorders in the fetus.

A client at 32 weeks' gestation receives an ultrasound that identifies intrauterine growth restriction. Which findings from the client's nutritional assessment would indicate to the nurse that additional teaching is needed? Select all that apply. maternal age less than 18 years eating large quantities of empty-calorie foods consuming 5 to 6 small meals each day history of gestational diabetes in previous pregnancy difficulty eating because of continuing nausea

eating large quantities of empty-calorie foods difficulty eating because of continuing nausea maternal age less than 18 years Explanation: Low caloric intake because of continued nausea as well as eating large quantities of empty calories can impact fetal growth. Pregnant adolescents also are more likely to have poor fetal growth because the adolescent's growth needs are competing with the fetus for nutrients. Consuming small, frequent meals is a strategy for increasing caloric and nutrient intake during pregnancy. A history of gestational diabetes makes it more likely the client will experience elevated blood glucose levels and fetal macrosomia.

What areas of teaching would the nurse cover during the preconception visit? Select all that apply. beginning high-intensity exercise finding a pediatric provider refraining from alcohol intake attending child care classes eating nutrient-dense foods

eating nutrient-dense foods refraining from alcohol intake Explanation: The preconception visit is focused on getting the woman healthy in preparation for pregnancy: healthy nutrition and refraining from alcohol use would be included. Finding a pediatric provider and child care classes would be teaching items during the second and third trimester of the pregnancy. While the woman would be encouraged to get exercise, this is not the time to begin a high-intensity exercise program.

A nurse is providing teaching to a prenatal class on genetic testing. Which factor should the nurse include as placing a couple at a higher risk for having a child with a genetic disorder? Select all that apply. paternal obesity maternal type 1 diabetes family history of genetic disorder maternal age of greater than 35 years paternal thyroid disease

maternal age of greater than 35 years family history of genetic disorder Explanation: The nurse should explain that fertility decreases after 35 years of age and that a family history up to three generations increases the risk for genetic disorders.

A woman comes to the clinic reporting her period is late and she is wondering if she is pregnant. Which assessment findings by the nurse would indicate she is exhibiting probable signs of pregnancy? Select all that apply. softening of the cervix positive pregnancy test auscultation of a fetal heart beat absence of menstruation ballottement ultrasound visualization of the fetus

positive pregnancy test ballottement softening of the cervix Explanation: Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply. reduced stomach acidity increased estrogen level elevated human placental lactogen (hPL) elevated human chorionic gonadotropin (hCG) increased red blood cell (RBC) production

reduced stomach acidity elevated human chorionic gonadotropin (hCG) increased estrogen level Explanation: The hCG levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization. This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Reduced stomach acidity and high levels of circulating estrogens are also believed to cause morning sickness. Elevation of hPL and RBC production do not cause morning sickness. hPL increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism. The increase in RBCs is necessary to transport the additional oxygen required during pregnancy.

A nurse is teaching a pregnant woman about ways to prevent the development of the food-borne illness listeriosis. The nurse determines that the teaching was successful when the woman identifies the need to avoid which food(s)? Select all that apply. pasteurized milk canned tuna fish refrigerated meat spreads soft cheeses store-made chicken salad

soft cheeses refrigerated meat spreads store-made chicken salad Explanation: To prevent listeriosis, the woman should avoid soft cheeses such as feta, Brie, Camembert, and blue-veined cheeses, refrigerated pâté or meat spreads, refrigerated smoked seafood unless it is an ingredient in a cooked dish such as a casserole, salads made in the store such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad, and unpasteurized milk. It is safe to eat canned or shelf-stable pâté and meat spreads and canned fish such as salmon and tuna or shelf-stable smoked seafood.

The nurse is reviewing all of the documentation on determining estimated date of delivery. Which objective data is included? Select all that apply. CT Scan Pelvic exam findings sonogram last day of menstrual period fundal height calculating Naegele rule

sonogram fundal height calculating Naegele rule Explanation: The following provide objective data on the estimated date of delivery (EDD). The sonogram (a gold standard) provides detailed fetal measurements confirming the gestational age. The fundal height provides growth data, and Naegele rule calculates the estimated date of delivery using the first day of the last menstrual period. A CT scan is not ordered. Pelvic exam findings provide data that the client is pregnant and can also provide data that true labor has begun.

A pregnant client is concerned about gaining weight. The nurse explains that the extra calories are needed for which purpose? Select all that apply. sustaining the elevated metabolic rate supplying energy to the fetus building strength for the birth process providing energy for increased workload promoting cellular growth

supplying energy to the fetus sustaining the elevated metabolic rate providing energy for increased workload promoting cellular growth Explanation: Increased maternal caloric intake is needed to provide energy and cellular growth in the fetus as well as to provide for the increased workload and metabolic rate of the maternal body. Increased caloric intake does not build strength for the birth process.