Maternal Child Nursing Care: Chapter 6-9 Uncomplicated Pregnancy

The nurse is performing a physical assessment of a pregnant patient. What precaution will the nurse take to prevent supine hypotension in the patient? 1 Place a small wedge under the patient's right hip. 2 Give a back massage to the patient before assessment. 3 Instruct the patient to empty her bladder before assessment. 4 Instruct the patient to drink warm milk before assessment.

1 An abdominal examination is part of a physical assessment. For abdominal examination, the patient lies on her back, and the weight of her abdominal contents compresses the vena cava and aorta, which results in supine hypotension. Therefore, during a physical assessment the nurse should place a small wedge under the patient's right hip to prevent supine hypotension. A back massage is helpful for promoting sleep, not for preventing supine hypotension. The nurse should instruct the patient to empty her bladder for fundal assessment, but emptying the bladder does not prevent supine hypotension. Intake of warm milk promotes sleep, but it does not prevent supine hypotension during a physical assessment.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein-containing foods? Select all that apply. 1 Dried beans 2 Seeds 3 Peanut butter 4 Bagel 5 Eggs

1, 2, 3, 5 Dried beans, seeds, peanut butter, and eggs provide protein. A bagel is an example of a whole grain food, not protein.

The nurse is assessing a patient with couvade syndrome. What symptoms is the nurse likely to find? Select all that apply. 1 Nausea 2 Skin rashes 3 Sore throat 4 Weight gain 5 Persistent cough

1, 4 Couvade syndrome is a condition in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. During this condition some emotional and physiologic changes are observed in the men. Couvade syndrome does not have any impact on the skin or throat. Therefore the patient will not have skin rashes, sore throat, or persistent cough.

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply. 1 Sardines 2 Avocadoes 3 Cooked pasta 4 Wheat bread 5 Refried beans

1, 5 Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.

The nurse works in a maternity unit. Which patient condition in her history would be a contraindication for epidural anesthesia during labor? 1 Appendectomy 2 Spinal surgery 3 Uterine surgery 4 Pelvic floor problems

2 The patient with a history of spinal surgery should not undergo epidural anesthesia. The patient with a history of appendectomy, uterine surgery, or pelvic floor problems can undergo epidural anesthesia.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? 1 38% Hct; 14 g/dL Hgb 2 35% Hct; 13 g/dL Hgb 3 33% Hct; 11 g/dL Hgb 4 32% Hct; 10.5 g/dL Hgb

3 33% Hct; 11 g/dL Hgb represents the lowest acceptable value during the first and the third trimesters. 38% Hct; 14 g/dL Hgb is within normal limits in the nonpregnant woman. 35% Hct; 13 g/dL Hgb is within normal limits for a nonpregnant woman. 32% Hct; 10.5 g/dL Hgb represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system (#-#-#-#-#) to describe this woman's current obstetric history, the nurse records ____________________________.

4-1-2-0-2 Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as: 4T: 1 = term birth at 41 weeks of gestation (son) 4P: 2 = preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = abortion: none occurred 4L: 2 = living children: her son and her daughter.

A pregnant patient asks the nurse, "How can I prevent blockage of the nipples while breastfeeding when my baby is born?" What cleaning instructions should the nurse provide to the patient regarding nipple care? 1 "Use soap." 2 "Apply tincture." 3 "Use alcohol." 4 "Rinse with warm water."

4. "Rinse with warm water."

List the time span in calendar months and weeks that indicates the appropriate length for a normal pregnancy. Record your response as whole numbers separated by commas.

9, 40 Pregnancy lasts approximately 9 calendar months or 40 weeks. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth.

A patient reveals the first day of the last menstrual period (LMP) as November 25, 2014. After an assessment, the nurse confirms that the patient is pregnant. What will be the estimated date of birth (EDB)?

09/02/2015 According to Nägele's rule, the estimated birth date is calculated by adding 7 days to LMP and counting forward 9 months. Hence, because the patient's LMP is November 25, 2014, the expected birth date would be 25 + 7 days = 32 days (December 2, 2014), plus 9 months, for an EDB of September 2, 2015.

The primary health care provider has ordered 300 mcg of immunoglobulin to be delivered intramuscularly to a pregnant patient. What would be the reason for administering this to the patient? The patient: 1 Is Rh negative and unsensitized. 2 Has elevated amniotic fluid volume. 3 Has group B streptococcal infection. 4 Is human immunodeficiency virus (HIV) positive

1 A patient who is Rh negative or Rh unsensitized should receive 300 mcg immunoglobulin (Rhogam) to prevent complications in the fetus related to Rh incompatibility. Elevated amniotic fluid volume (or polyhydramnios), streptococcal infection, and HIV infection cannot be treated with immunoglobulin. Severe polyhydramnios is treated by aspirating a small amount of amniotic fluid (amniocentesis). If a patient tests positive for group B streptococcal infection, antibiotic therapy is initiated. If the pregnant patient is HIV positive, antiretroviral drugs are administered to prevent transmission of infection from the mother to the child.

The nurse is assessing a patient who weighs 57 kg in the first month of pregnancy. The nurse plans a diet regimen to provide adequate nutrition to the patient. Which assessment finding at the end of the third month would indicate that the diet prescribed was effective? The patient: 1 Weighs 59 kg. 2 Weighs 62 kg. 3 Has good-quality sleep. 4 Has regular bowel moments.

1 A pregnant patient usually has nausea and vomiting during the first trimester. The nurse should ensure proper nutrition by prescribing an appropriate diet plan. Ideally, the patient should gain 2 kg body weight by the end of the first trimester. Thus the patient should weigh 59 kg (57 + 2) by the end of her first trimester. Excess weight gain (62 kg) is not a good sign in pregnancy and could lead to complications such as gestational hypertension and gestational diabetes. Sleep disturbances and constipation are commonly observed in the second trimester of pregnancy. These problems are not associated with maternal weight gain or impaired nutrition.

During a woman's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse documents this finding as the: 1 Hegar sign. 2 McDonald sign. 3 Chadwick sign. 4 Goodell sign

1 At approximately six weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign is flexibility of the uterus at the junction of the cervix and uterus and usually can be detected at seven to eight weeks of gestation. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse should be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important? 1 Several glasses of fluid 2 Extra protein sources, such as peanut butter 3 Salty foods to replace lost sodium 4 Easily digested sources of carbohydrate

1 If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also, the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

The blood pressure of a pregnant patient becomes low when the patient lies on the back. What would be the best nursing intervention to maintain normal blood pressure in the patient? 1 Position the patient to lie on the left side and rest. 2 Suggest that the patient perform aerobic exercises daily. 3 Have the patient stand up and take a deep breath. 4 Tell the patient to lie straight facing up and take frequent rest periods.

1 Pregnant women often experience hypotension when they lie on their back (in the supine position). The blood that is trying to return to the right atrium is diminished because the uterus is compressing the vena cava. Therefore the nurse should have the patient to lie on either side to rest. This will reduce the uterine pressure on the right atrium and helps in optimal circulation. Aerobic exercise will not be helpful in reducing the pressure caused by uterine compression. Making the patient stand up and take deep breaths will worsen the symptoms of hypotension. Making the patient lie in the supine position will further increase the uterine compression and hypotension.

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: 1 prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. 2 the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. 3 killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. 4 no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

1 Prescription and OTC drugs can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply. 1 Underweight women should gain 12.5 to 18 kg. 2 Overweight women should gain at least 7 to 11.5 kg. 3 Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. 4 In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. 5 Normal weight women should gain 11.5 to 16 kg.

1, 2, 3, 5 Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg), but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.

After assessing a pregnant patient, the nurse finds that the patient has carpal tunnel syndrome. Which symptoms helped the nurse to arrive at this conclusion? Select all that apply. 1 Tingling 2 Numbness 3 Increased sweating 4 Dropping of objects 5 Flatulence and bloating

1, 2, 4 Carpal tunnel syndrome results from compression of the median nerve caused by changes in the surrounding tissues. Tingling, numbness, and dropping of objects are symptoms of carpal tunnel syndrome. It causes pain and loss of skilled movements. During pregnancy, the sweat glands are more active, and this results in increased sweating. Flatulence with bloating occurs during pregnancy because of reduced gastrointestinal motility caused by hormonal changes.

Following the complete assessment and review of the medical reports of a pregnant female, the nurse concludes that the female is in week 32 of pregnancy. What findings are consistent with the nurse's conclusion? Select all that apply. 1 Fetal movements are clearly visible. 2 Cardiac output of the patient is increased. 3 Uterus is almost the size of a grapefruit. 4 Braxton Hicks contractions are observed.

1, 2, 4 The fetal movements are clearly visible on ultrasound during week 32 of pregnancy as the fetus is developed and active. An increase in the cardiac output around 30% to 50% is seen in week 32, which later declines by about 20% in week 40. Braxton Hicks contractions are irregular, painless contractions, which become definite after week 28 of pregnancy. The uterus is almost the size of a grapefruit in week 12, which increases later because of mechanical pressure of the fetus.

If exhibited by an expectant father, what is a warning sign of ineffective adaptation to his partner's first pregnancy? 1 Views pregnancy with pride as a confirmation of his virility 2 Consistently changes the subject when the topic of the fetus/newborn is raised 3 Expresses concern that he might faint at the birth of his baby 4 Experiences nausea and fatigue, along with his partner, during the first trimester

2 Persistent refusal to talk about the fetus may be a sign of a problem and should be assessed. Viewing the pregnancy with pride is normal. Expressing concern about fainting at the birth is normal. Experiencing pregnancy-like symptoms is called couvade syndrome.

The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient? Select all that apply. 1 Mucoid discharge from the cervix 2 Heaviness in the patient's breasts 3 Milk discharge from the patient's nipples 4 Decreased chest expansion of the patient 5 Well-defined pink blotches on the palm

1, 2, 5 High levels of estrogen during pregnancy increase the production of cervical mucus. Therefore pregnant women have copious white or gray cervical discharge. Increased estrogen levels increase the blood supply to the breasts, thereby causing breast heaviness. The presence of well-defined pink blotches on the palm, referred to as palmar erythema, is also the effect of increased estrogen levels during pregnancy. Milk production is possible only when the baby has been delivered and there is a decreased estrogen level in the body. High levels of estrogen cause laxity of the ligaments of the rib cage, which increases the chest expansion.

What measures should the nurse instruct a pregnant patient to take to relieve the symptoms of morning sickness during the first trimester? Select all that apply. 1 Consume food when it is not hot. 2 Eat food in smaller portions. 3 Include smaller amounts of fluids. 4 Include foods that are high in fats. 5 Include food high in starch content.

1, 2, 5 Morning sickness is seen in most women during the first trimester. Hot foods have strong odors, which may stimulate the chemoreceptor trigger zone and cause nausea. Therefore the nurse should advise the patient to ingest the food when it is not too hot. The patient is usually taught to have smaller, more frequent meals every 2 to 3 hours because it prevents stomach distention. Starch reduces the concentration of gastric acid, which aids in preventing nausea. Therefore the nurse should teach the patient to incorporate foods that contain higher quantities of starch. Usually patients are instructed to include higher amounts of fluids during pregnancy to prevent dehydration caused by nausea. Fried foods and foods rich in fats tend to produce more acids that can aggravate nausea and contribute to reflux.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response is to tell the woman that her pattern of weight gain should be approximately: 1 a pound a week throughout pregnancy. 2 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. 3 a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. 4 a total of 25 to 35 lbs

2 A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy is about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb per week during the second and third trimesters. One pound per week is not the correct guideline during pregnancy. One pound per week during the first two trimesters and two pounds per week thereafter is not the correct guideline for weight gain during pregnancy. A total weight gain of 25 to 35 pounds is correct, but the pattern needs to be explained to the woman.

A pregnant woman at 7 weeks of gestation complains to her nurse-midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse-midwife should suggest that the woman: 1 drink warm fluids with each of her meals. 2 eat a high-protein snack before going to bed. 3 keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. 4 schedule three meals and one midafternoon snack a day.

2 A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that can contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman experiencing nausea and vomiting should: 1 drink a glass of water before getting out of bed in the morning. 2 eat small, frequent meals (every 2 to 3 hours). 3 increase her intake of high-fat foods to keep the stomach full and coated. 4 limit fluid intake throughout the day.

2 A pregnant woman experiencing nausea and vomiting should eat small, frequent meals. She should avoid consuming fluids early in the day or when nauseated. She should reduce her intake of fried foods and other fatty foods and should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: 1 constipation. 2 alteration in the pattern of fetal movement. 3 heart palpitations. 4 edema in the ankles and feet at the end of the day.

2 An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

As the pregnancy progresses, the patient experiences shortness of breath when the fundal height is being assessed. What action should the nurse take to minimize the shortness of breath or dizziness as a result of the weight of the growing uterus? 1 Use a new paper tape measure for each visit to decrease infection. 2 Place a small towel under the patient's right hip. 3 Place a pillow under the patient's knees whenever she is on her back. 4 Place the patient on her right side while the measurement is done.

2 Placing a small towel under the patient's right hip decreases the direct pressure on the major vessels in the abdomen, which become compressed when the patient lies on her back. Infection control is not an issue at this time. Placing a pillow under her legs may make the patient more comfortable, but won't improve perfusion. Placing the patient on her right side does not allow for proper measurement while maximizing perfusion.

The nurse is assessing a pregnant female who has signs of ballottement and increased pulse rate. The nurse is able to visualize the fetus by radiography images, but the laboratory reports show a negative urine pregnancy report. What is the most probable age of the fetus? 1 6 weeks 2 16 weeks 3 26 weeks 4 36 weeks

2 An increase in the pulse rate is seen in between 14 and 20 weeks of gestation in a pregnant female. Ballottement is a sign of passive movements in the fetus, which is generally observed between weeks 16 and 18 of pregnancy. The fetus can be visualized by radiographic images during week 16 of pregnancy. Human chorionic gonadotropin (hCG) levels in the urine decline after 60 days of pregnancy (week 12), which results in a negative urine pregnancy test. Therefore the probable age of the fetus is 16 weeks. In week 6 of pregnancy, the fetus is not visualized by radiography. In weeks 26 and 36, signs of ballottement and increased pulse are not seen, but fetal movements are observed.

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester? 1 Less audible heart sounds (S1, S2) 2 Increased pulse rate 3 Increased blood pressure 4 Decreased red blood cell (RBC) production

2 Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

The nurse is assessing a patient who has an unplanned pregnancy. The patient says to the nurse, "My partner is not happy that I'm pregnant." What should be a relevant response by the nurse? "Your partner should: 1 Be advised to play with children." 2 Be given adequate time to adapt to the idea of having a baby." 3 Be encouraged to develop a new hobby." 4 Visit an orphanage a for few days."

2 During an unplanned pregnancy, some partners find it difficult to accept the impending changes in life plans and lifestyles, but over time they adapt to the reality of pregnancy. Because the patient's partner is not mentally prepared for the baby, it is not advisable to ask the partner to play with children, develop a new hobby, or visit an orphanage.

While assessing a pregnant patient, the nurse finds that the patient has increased flatulence, bloating, and belching. Which intervention should the nurse suggest to reduce this discomfort? 1 "Drink acidophilus milk regularly." 2 "Chew foods slowly and thoroughly." 3 "Increase consumption of fatty food." 4 "Increase fluid intake before bedtime."

2 During pregnancy, gastrointestinal motility is reduced by changes in hormone levels. This increases bacterial action and results in gas production, which results in flatulence, bloating, and belching. Therefore, to improve digestion and prevent gas production, the nurse should advise the patient to chew foods slowly and thoroughly. Drinking acidophilus milk prevents urinary tract infection but does not help reduce flatulence. The patient should avoid consuming fatty food because it increases flatulence and belching. The patient should not increase fluid intake before bedtime because it may cause frequent urination.

When assessing a pregnant woman in the second trimester, the nurse finds the patient to be healthy, but the patient reports mild edema. What should the nurse infer from this finding? 1 The patient has a vitamin B deficiency. 2 This is a normal finding; it results from estrogen. 3 The patient is consuming too many calories. 4 The nurse should check the blood glucose

2 Edema usually refers to the abnormal accumulation of fluid in the interstitium. In the past it was believed to be caused by an excess of sodium. However, a moderate amount of edema is considered normal. This happens because of higher estrogen levels. Vitamin B deficiency causes neural tube defects. Taking in too many calories does not cause edema; it causes weight gain. Glucose is the basic source for energy, deficiency of which causes hypoglycemia and reduces stamina. However, it does not cause edema.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? 1 "Many pregnant women imagine what their baby is like." 2 "A baby in utero does respond to the mother's voice." 3 "You'll need to ask the doctor if the baby can hear yet." 4 "Thinking that your baby hears will help you bond with the baby."

2 Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice. Although stating that many pregnant women imagine what their baby is like is accurate, it is not the most appropriate response. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice. Stating that if the woman thinks that her baby hears will help them bond gives the impression that her baby cannot hear her. It also belittles the mother's interpretation of her fetus's behaviors.

The nurse is assessing a pregnant patient who complains of painful urination. The patient says, "My urine is dark in color." What will the nurse tell the patient to do? 1 "Take bubble baths regularly." 2 "Increase your fluid intake." 3 "Include dry carbohydrates in your diet." 4 "Get regular back rubs."

2 If a pregnant patient has less than the recommended fluid intake, her urine could be of a dark color. Therefore the nurse should advise the patient to increase her fluid intake to help dilute her urine. Bubble baths are usually not recommended in pregnant women because they may irritate the urethra. The pregnant patient is advised to take dry carbohydrates to prevent vomiting during the first trimester of pregnancy, but a dry carbohydrate diet has no effect on the patient's urination patterns. Regular back rubs can ease back pain in the pregnant patient, but they have no effect in diluting the urine.

The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret from this? The husband has: 1 Vena cava syndrome. 2 Couvade syndrome. 3 Carpal tunnel syndrome. 4 Brachial plexus traction syndrome.

2 Intake of dry carbohydrate is recommended in pregnant patient's diet to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome.

The nurse observes that a patient has severe itching during pregnancy. Which function in the patient is affected? 1 Renal function 2 Hepatic function 3 Respiratory function 4 Gastrointestinal function

2 Severe itching in the pregnant woman is a condition called pruritus gravidarum. It is the result of intrahepatic cholestasis (accumulation of bile in the liver) caused by placental steroids. Hence, the hepatic function was affected in the patient. Itching is not indicative of renal, pulmonary, or gastrointestinal function. Glucosuria and proteinuria indicate that the renal function is affected. Nasal stuffiness, sinus stuffiness, and epistaxis indicate that the upper respiratory function is impaired. Pyrosis or heartburn indicates that the gastrointestinal function is impaired.

The nurse is reviewing the diagnostic test results with a pregnant patient and informs the patient that she is going to have twins. Based on which diagnostic test did the nurse make such a conclusion? 1 Human placental lactogen 2 Ultrasound results 3 Cytogenetic testing 4 Amniotic fluid levels

2 Ultrasound scan or fetal ultrasound is the technique used for visualizing the fetus and the internal structures for prenatal analysis. In this technique, high-frequency sound waves produce the image of the fetus without harming the fetal internal organs. Therefore this technique is used to identify the presence of twins in the patient's womb. Human placental lactogen changes the metabolism of the mother and supplies energy to the fetus. Cytogenetic testing helps find the genetic abnormalities and that caused by changes in the chromosomes. Amniotic fluid protects the fetus from injuries. These tests do not help determine the presence of twins in the patient's womb.

Before conducting the ultrasound scan, the nurse instructs the pregnant patient on the procedure. Which statement made by the patient indicates the need for further teaching? 1 "The sound waves are not harmful to the fetus at all." 2 "A needle is inserted in the abdomen during the scan." 3 "The frequency of the sound produced can be adjusted." 4 "Fetal anomalies can be identified by ultrasound scan."

2 Ultrasound testing is performed using high-frequency sound waves to obtain an image of the fetus. This technique is painless and a needle is not inserted in the womb. If the patient asks about the insertion of a needle in ultrasound, it implies that the patient did not understand about the technique and requires further teaching. A needle is used for an amniocentesis. These sound waves do not harm the fetus, and their frequency can be adjusted. This technique helps to identify the fetal abnormalities, because it shows the image of the fetus.

The nurse instructs a pregnant patient to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease? 1 Constipation 2 Varicose veins 3 Supine hypotension 4 Urinary tract infections

2 Varicose veins are observed in pregnant patients usually in the second or third trimesters. Prolonged sitting increases the blood pressure in the legs veins, causing varicose veins. Patients who spend more time sitting (e.g., at a desk job) have a high risk for developing varicose veins. Similarly, wearing tight-fitting pants can also affect the venous return and cause stasis of the blood in the veins. Constipation is another regularly observed complication during pregnancy. Increased intake of fiber and water is helpful to relieve constipation. Supine hypotension is caused when the abdominal contents compress the inferior vena cava in the supine position. This can be relieved by changing the positions when sleeping. Urinary tract infections can be prevented during pregnancy by increasing the intake of water and by emptying bladder regularly.

The nurse is assessing a 3-month pregnant patient who is given folic acid supplement. The patient is worried because of the appearance of reddish spider-like rashes on the face and neck. What does the nurse tell the patient about these rashes? 1 "This is a side effect of folic acid." 2 "This disappears after pregnancy." 3 "This is caused by a food allergy." 4 "This is caused by decreased estrogen."

2 Vascular spider-like rashes are tiny, star-shaped or branched, slightly raised, and pulsating end-arterioles usually found on the neck, thorax, face, and arms during pregnancy. These spider-like rashes usually disappear after pregnancy. The appearance of vascular spider-like rashes is common during the 2 to 5 months of pregnancy and is not a result of a food allergy. Folic acid supplementation is given in pregnancy to reduce birth defects. Folic acid does not cause vascular or skin changes. Vascular spider-like rashes are not caused by elevated estrogen levels.

The nurse advises an alcoholic patient to stop consuming alcohol during pregnancy. What could be the reason for this? To prevent: 1 Angiomas in the fetus 2 Urinary infections in the patient 3 Teratogenic effect in the fetus 4 Gastrocnemius spasm in the patient

3 Alcohol has teratogenic effects such as fetal alcohol syndrome. It causes devastating effects and impairs fetal development. Therefore, to prevent these teratogenic effects the nurse should advise the pregnant patient to avoid consuming alcohol. Angiomas (spider nevi) result from an increased concentration of estrogen in the pregnant women. They are not caused by alcohol consumption. Alcohol consumption has no effect on the urinary system. Gastrocnemius spasm results from low levels of diffusible serum calcium or elevation of serum phosphorus.

The nurse is assessing a patient who is pregnant and has diabetes. The Doppler ultrasound examination shows that there is a decrease in the uterine blood flow velocity. Which is the reason for reduced uterine blood flow in the patient? 1 Reduced estrogen levels 2 Lying in the lateral position 3 Low arterial blood pressure 4 Relaxation of the uterine muscles

3 An increase in the arterial pressure increases the velocity of blood flow to the uterus. Therefore low arterial pressure decreases the uterine blood flow velocity and thereby decreases the blood supply to the fetus. Supine position of the mother decreases the intervillous blood flow. Therefore lateral position is preferred for sleeping. The blood flow would be the highest in this position, compared with the supine and prone positions. Estrogen has a vasodilator effect. Therefore reduced estrogen levels would decrease the velocity of the uterine blood flow. Contraction of the uterine muscles reduces the blood flow, whereas relaxation of the uterine muscles increases the blood flow.

The nurse is teaching a patient with anemia when and how to take the prescribed iron supplements. The nurse provides a list of beverages for the patient to stay away from while taking the iron supplement. What is the rationale for this? 1 They can affect the process of hematopoiesis. 2 They increase red blood cell (RBC) destruction. 3 They can decrease iron supplement absorption. 4 They can increase the plasma levels of caffeine.

3 Anemia is caused by decreased hemoglobin levels in the blood, which, in turn, is caused by decreased iron intake. Iron supplements are usually given to treat iron deficiency anemia. Tea, coffee, and milk decrease iron absorption, which reduces the efficiency of iron supplements. Therefore the nurse teaches the anemic patient to stop drinking tea, coffee, and milk with the iron supplement. Tea, coffee, and milk do not affect the plasma levels of caffeine, the hematopoiesis process, or cause RBC destruction.

A pregnant patient complains of constipation. While checking the patient's history, the nurse learns that the patient is taking oral iron supplements. What instruction does the nurse give the patient to relieve constipation? 1 "Drink mineral oil before going to bed." 2 "Take a stool softener before going to bed." 3 "Drink six to eight glasses of water every day." 4 "Discontinue taking iron supplements."

3 Because of their reduced gastrointestinal tract motility and intestinal compression, constipation is a common complaint among pregnant women. Gastrointestinal motility is reduced by changes in progesterone levels, which increases reabsorption of water. This in turn leads to the drying of stools, or constipation. Therefore the nurse should instruct the patient to drink six to eight glasses of water every day. During pregnancy, the nurse should not instruct the patient to take mineral oil or stool softener because they may be harmful to the fetus; these are prescribed only by the primary health care provider. Constipation may result from oral iron supplementation, but the nurse should not instruct the patient to stop taking iron supplementation because iron supplements are essential to prevent anemia.

A patient reports to the nurse that she had missed her period this month and suspects that she is a pregnant. What would be the most suitable nursing action for this patient? 1 Assess for Hegar sign. 2 Assess for Chadwick sign. 3 Obtain an order for a serum pregnancy test.

3 Because the woman has missed her period, it is likely that the woman is 4 to 6 weeks pregnant. A serum pregnancy test helps in the earliest detection of pregnancy. This test can be used to detect pregnancy in women who are 4 weeks pregnant. Therefore the nurse should ask the patient to take the serum pregnancy test. It is performed during weeks 4 to 12 of pregnancy. Hegar sign and Chadwick signs will be observed during weeks 6 to 12 of pregnancy, and pelvic congestion may be the other cause for such signs. Urine pregnancy test gives positive results during weeks 6 to 12 of pregnancy.

During the first trimester, the pregnant woman is most motivated to learn about: 1 fetal development. 2 impact of a new baby on family members. 3 measures to reduce nausea and fatigue so she can feel better. 4 location of childbirth preparation and breastfeeding classes.

3 During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family is an appropriate topic for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester, a woman works on the task of, "I am going to have a baby." Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: 1 "This is normal behavior and should begin to subside by the second trimester." 2 "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." 3 "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." 4 "You seem impatient with her. Perhaps this is precipitating her behavior."

3 Emotional lability, rapid and unpredictable changes in mood, is related to hormone changes and anxiety during pregnancy. Stating that the woman's behavior is normal is correct but does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This statement is judgmental and not appropriate.

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? 1 Morning sickness 2 Quickening 3 Positive pregnancy test 4 Fetal heartbeat auscultated with Doppler/fetoscope

4 Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination are positive signs diagnostic of pregnancy . Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) because error can occur in performing the test or, in rare cases, human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today because pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy.

The nurse notices that a pregnant patient is worried about gaining weight and has stayed away from eating foods high in carbohydrates. What should the nurse do to ensure adequate nutrition? 1 Inform the patient that lack of proper nutrition may delay the newborn's delivery date. 2 Suggest the patient increase her protein intake to compensate for the carbohydrate levels. 3 Inform the patient that breastfeeding aids in losing the weight gained during pregnancy. 4 Inform the patient that a decreased intake of carbohydrates during pregnancy causes fetal obesity.

3 Some patients decrease their food intake during pregnancy for fear of weight gain. This may affect fetal development. Therefore the nurse should teach the patient to maintain adequate nutrition. When the patient delivers the baby and begins to breastfeed, this will aid postpartum weight loss. However, most of the weight is lost after the child's birth due to reduction of fat. There is no evidence that reduced consumption of carbohydrates may cause fetal obesity. Fetal obesity can happen as a result of maternal obesity. Lack of proper nutrition causes ketonuria, which may lead to preterm delivery, not a delay in the delivery. Ketonuria happens because the body breaks down fats for energy because of the lack of carbohydrates. Carbohydrates and proteins are essential for fetal development. Therefore the nurse should suggest the patient eat a balanced diet, rather than increasing the intake of protein.

How many veins and arteries are present between the maternal and the fetal circulatory system at birth? 1 One vein and one artery 2 Two veins and one artery 3 One vein and two arteries 4 Two veins and two arteries

3 The fetal heart starts beating by the end of the fifth week. Two arteries carry blood from the embryo to the chorionic villi, and one vein returns the blood to the embryo. Deoxygenated blood leaves the fetus through the umbilical arteries and enters the placenta, where it is oxygenated. Oxygenated blood leaves the placenta through the umbilical vein, which enters the fetus via the umbilical cord. It is rare for there to be one vein and one artery. Approximately 1% of umbilical cords contain only two vessels: one artery and one vein. This occurrence is sometimes associated with congenital malformations. Therefore the presence of two veins and one artery and two veins and two arteries is inappropriate.

The nurse is reviewing the lab reports of a patient who is 10 weeks pregnant and has a family history of diabetes mellitus. The nurse finds that the patient's 1-hour glucose tolerance test is normal. What does the nurse advise the patient? 1 "Undergo a renal function test." 2 "Increase food intake." 3 "Repeat the test at 28 weeks." 4 "Undergo a 3-hour glucose test."

3 The pregnant patient has a family history of diabetes and may be at a high risk for developing gestational diabetes. Because the initial 1-hour glucose tolerance test results are normal, the patient should be advised to repeat the test again at 28 weeks of pregnancy. The patient has normal blood sugar levels and is therefore unlikely to have renal complications. The patient does not need to undergo a renal function test. The laboratory reports do not indicate that the patient has any nutritional deficiencies and does not indicate a need for the patient to increase her food intake. A 3-hour glucose test is conducted only for pregnant patients whose 1-hour glucose tolerance test is positive.

What question does the nurse ask while assessing the socioeconomic status of a pregnant patient? 1 "What prescription medications do you take?" 2 "Do you have any factories around your house?" 3 "Do you have any medical or dental insurance?" 4 "Are there any diseases that run in your family?"

3 When the nurse is assessing a patient's socioeconomic status, the nurse should determine whether the patient has health insurance. Lack of health insurance may mean the patient does not have a job to pay for insurance or the income to pay for it privately. This may affect the patient's prenatal care if she cannot afford services. When the nurse asks about the family's medical history, this falls under the patient's personal history. The nurse asks about the community in which the patient lives when assessing the patient's environment. Medications can affect the fetus in a pregnant patient. Therefore the nurse should ask about the medications taken by the patient when assessing the patient's health status.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. Record her gravidity and parity using the GTPAL system as x-x-x, etc.

3-1-0-1-0 Using the GPTAL system , this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time); T: Number of pregnancies carried to term (she has one stillborn); P: Number of pregnancies that resulted in a preterm birth (she has none); A: Abortions or miscarriages before the period of viability (she has had one); L: Number of children born who are currently living (she has no living children)

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus? 1 Nuts, beans and legumes, cocoa, meats, and whole grains 2 Iodized salt, milk and milk products, yeast breads, and rolls 3 Citrus fruits, broccoli, melons, strawberries, and tomatoes 4 Asparagus, eggs, fortified cereals, and green leafy vegetables

4 A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.

The biochemical reports of a pregnant woman show an increase in the metabolism of glucose and increased fatty acid deposition of the body. Which hormone is responsible for these changes in the patient? 1 Insulin 2 Estrogen 3 Parathyroid 4 Human chorionic somatotropin

4 Human chorionic somatotropin decreases the maternal metabolism of glucose and increases the production of fatty acids for metabolic needs. A decrease in the metabolism of glucose and increased fatty acid deposition is caused by the decrease in human chorionic somatotropin. The metabolism of glucose and fatty acid deposition is not affected by the defect in insulin, estrogen, and parathyroid. In pregnant females, insulin is produced to repress the effect of insulin antagonism by placental hormones. A defect in insulin does not lead to the increase of metabolism in glucose. Estrogen is responsible for fatty acid deposition but is not involved in glucose metabolism. Parathyroid hormone controls the metabolism of calcium and magnesium.

The nurse is caring for a 3-month pregnant woman who reports, "I always feel very thirsty." What does the nurse infer from the patient's statement? The patient: 1 Consumes less fiber in the diet. 2 Takes high amounts of fat in the diet. 3 Has high sodium content in the blood. 4 Has increased loss of water from the body.

4 In early pregnancy, the kidneys have increased capacity to excrete water. Therefore the patient may feel thirsty because of increased loss of water. A low-fiber diet may cause constipation in pregnant females. Fiber does not interfere with the water levels in the body. Consumption of fatty foods in proper amounts is necessary in pregnancy, and fatty foods usually do not cause excess thirst. Sodium ions trigger fluid retention in the body and do not cause thirst.

A pregnant woman reports a sudden discharge of fluid from the vagina before 37 weeks' gestation. What does the nurse infer from this observation? This is a sign of: 1 Renal calculus in the patient. 2 Intrauterine fetal death. 3 Gestational diabetes mellitus. 4 Premature rupture of membrane

4 Sudden discharge of fluid from the vagina before 37 weeks indicates premature rupture of membranes. Severe backache or flank pain is sign of renal calculus (renal stone). Absence of fetal movements during the third trimester indicates intrauterine fetal death. A positive glucose tolerance test indicates gestational diabetes mellitus.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: 1 intercourse should be avoided. 2 intercourse is safe until the third trimester. 3 safer-sex practices should be used once the membranes rupture. 4 intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

4 Uterine contractions that accompany orgasm can stimulate labor and can be problematic if the woman is at risk for or has a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.